Abstract
Aims/hypothesisThe aim of the study was to examine trends in the incidence and case fatality of acute myocardial infarction (AMI) and in hospital admissions for angina and coronary revascularisation procedures in people with type 2 diabetes and in people without diabetes in Scotland between 2006 and 2015.MethodsIn this retrospective cohort study, AMI, angina and revascularisation event data were obtained for adults from hospital admissions and death records linked to a population-based diabetes register. Incidence by diabetes status was estimated using negative binomial models with adjustment or stratification by age, sex, deprivation and calendar year. Logistic regression was used to estimate AMI case fatality by diabetes status.ResultsThere were 129,926 incident AMI events, 41,263 angina admissions and 69,875 coronary revascularisation procedures carried out during 34.9 million person-years of follow-up. The adjusted incidence of AMI, angina and revascularisation procedures declined by 2.0% (95% CI 1.73%, 2.26%), 9.62% (95% CI 9.22%, 10.01%) and 0.35% (95% CI −0.09%, 0.79%) per year, respectively. The rate of decline did not differ materially by diabetes status. RRs of AMI for type 2 diabetes were 1.86 (95% CI 1.74, 1.98) for men and 2.32 (95% CI 2.15, 2.51) for women. Of the 77,211 people admitted to hospital with a first AMI, 7842 (10.2%) died within 30 days of admission. Case fatality was higher in people with type 2 diabetes than in people without diabetes and declined in both groups by 7.93% (95% CI 7.03%, 8.82%) per year.Conclusions/interpretationThe incidence of AMI, angina, revascularisation and AMI case fatality has declined over time, but the increased risk associated with type 2 diabetes has remained approximately constant.
Highlights
MethodsType 2 diabetes is known to be associated with an elevated risk of cardiovascular disease (CVD) morbidity and mortality
129,926 acute myocardial infarction (AMI) events, 41,263 angina admissions and 69,875 coronary revascularisations were recorded during 34.9 million person-years of follow-up between 2006 and 2015 in Scotland
The proportion of AMI events that were fatal prior to hospital admission was higher in men with type 2 diabetes than in men without diabetes, but proportions were similar by diabetes status in women (Table 1)
Summary
MethodsType 2 diabetes is known to be associated with an elevated risk of cardiovascular disease (CVD) morbidity and mortality. There have been considerable efforts to reduce the risk of CVD in people with type 2 diabetes, through more intensive risk factor control and newer diabetes treatments purported to confer specific cardiovascular benefits [6, 7]. It is not known whether these approaches have had an effect on the higher risk of CHD conferred by type 2 diabetes. There is a need for information on trends in the incidence of AMI, angina and procedures for CHD in people with diabetes.
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