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. 2019 Mar;62(3):418-425.
doi: 10.1007/s00125-018-4796-7. Epub 2019 Jan 17.

Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015

Stephanie H Read  1   2 , Colin M Fischbacher  3 , Helen M Colhoun  4 , Danijela Gasevic  5   6 , Joannes J Kerssens  3 , David A McAllister  7 , Naveed Sattar  8 , Sarah H Wild  5 ; Scottish Diabetes Research Network Epidemiology Group
Affiliations

Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015

Stephanie H Read et al. Diabetologia. 2019 Mar.

Abstract

Aims/hypothesis: The 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.

Methods: In 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.

Results: There 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/interpretation: The 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.

Keywords: Angina; Coronary heart disease; Myocardial infarction; Revascularisation; Type 2 diabetes.

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Conflict of interest statement

HMC reports grants, personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, Bayer, Eli Lilly, Novartis Pharmaceuticals, Regeneron, Pfizer, Roche Pharmaceuticals, Sanofi-aventis, Sanofi and Novo Nordisk outside the submitted work. NS reports grants and personal fees from Boehringer Ingelheim, Janssen, Novo Nordisk, Eli Lilly, Amgen, AstraZeneca and Sanofi outside the submitted work. No other potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1
Incidence of AMI by diabetes status, sex and age in years. The graphs illustrate modelled rates for (a) men and (b) women in deprivation decile 5 in the calendar year 2010 using negative binomial models. The shading shows 95% CIs. Points represent event rates stratified by age in 5-year bands, sex and diabetes diagnosis; the size of the points reflects the size of the denominator
Fig. 2
Fig. 2
Trends in incidence of AMI by diabetes status and calendar year illustrated for (a) men and (b) women in deprivation decile 5 and aged 55, 65 and 75 years. Estimates derived from the model are adjusted for age, sex, deprivation and interaction terms between sex and year, sex and diabetes status, diabetes status and year. The line colour depicts the age and the line type depicts the diabetes status. The shading shows 95% CIs
Fig. 3
Fig. 3
Case fatality within 30 days of hospital admission following AMI in (a) men and (b) women aged 55, 65 and 75 years, by calendar year and diabetes status. Estimates derived from model adjusted for age, sex, calendar year, deprivation status and interaction terms between sex and year, sex and diabetes status, deprivation and diabetes status, diabetes status and year. The line colour depicts the age and the line type depicts the diabetes status. The shading shows 95% CIs
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