Article

Long-term mortality following myocardial infarction is higher in
diabetic than non-diabetic individuals. Early case-fatality after myocardial
infarction has improved but it is unclear whether trends extend to long-term
mortality. We aimed to determine whether the disparity in long-term all-cause and
cardiovascular disease mortality by diabetes status has decreased. METHODS:
All incident myocardial infarction cases were identified from Western Australian
whole-population linked data for 1998-2009. Mortality follow-up was available
until 30 June 2011. Unadjusted survival was estimated using Kaplan-Meier survival
curves. Hazard ratios comparing five-year mortality in diabetic versus
non-diabetic people across three periods (1998-2001, 2002-2005, 2006-2009) were
estimated from multivariable Cox regression models, and adjusted trends
calculated from interaction (diabetes status x period) models. RESULTS: There
were 22,594 30-day survivors of incident MI. There was little change across the
three periods in all-cause mortality in diabetic men (27.1%, 28.2%, 25.5%) and
women (34.9%, 36.8%, 36.1%), but small declines from first to last periods in
non-diabetic men (14.5% to 12.1%, p = 0.03) and women (21.0% to 19.4%, p = 0.08).
There was no temporal change in the increased all-cause mortality hazard ratios
in diabetic versus non-diabetic men and women. Multivariable-adjusted relative
risk for cardiovascular disease mortality remained elevated in diabetic women
(2006-2009 hazard ratio 1.73, 95% confidence interval 1.29, 2.32) but not in men
(2006-2009 hazard ratio 1.08, 95% confidence interval 0.85, 1.37). CONCLUSIONS:
The excess long-term mortality associated with diabetes and excess cardiovascular
disease mortality in diabetic women indicates a need for improved secondary
prevention in diabetic patients, especially women.
CI - (c) The European Society of Cardiology 2016.

Langue : ANGLAIS