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Observational Study
. 2019 Mar;42(3):391-399.
doi: 10.1002/clc.23160. Epub 2019 Feb 25.

Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population

Suying Li  1 , Yi Peng  1 , Xinyue Wang  1 , Yi Qian  2 , Pin Xiang  2 , Sally W Wade  3 , Haifeng Guo  1 , J Antonio G Lopez  2 , Charles A Herzog  1   4   5 , Yehuda Handelsman  6
Affiliations
Observational Study

Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population

Suying Li et al. Clin Cardiol. 2019 Mar.

Abstract

Background: Survivors of myocardial infarction (MI) or ischemic stroke (IS) are at high risk for subsequent cardiovascular events.

Hypothesis: Older patients with prior MI or IS are at risk for recurrent cardiovascular events, and comorbidities such as diabetes may increase this risk.

Methods: Two cohorts were studied in a retrospective Medicare 20% random sample-a 2008 cohort with up to 6 years of follow-up (MI, N = 26 460; IS, N = 17 566) and a 2012 cohort with 1 year of follow-up (MI, N = 26 548; IS, N = 17 728).

Results: In older patients who survived an event of MI or IS (2012 cohort), 7.2% had a recurrent MI and 6.7% had a recurrent IS in the first year; 32% died. Accounting for multiple recurrent events (2012 cohort), the event rates per 100 patient-years were 11.6 and 10.2 for the MI and IS cohorts, respectively. Cumulative incidence of recurrence (2008 cohort) increased from 7.7% at 1 year to 14.3% at 6 years for recurrent MI and from 6.7% at 1 year to 13.4% at 6 years for recurrent IS. Comorbid diabetes (2012 cohort) was significantly associated (adjusted risk ratio) with MI recurrence (1.44) and risk of coronary revascularization (1.23) in the MI cohort and with IS recurrence (1.26) in the IS cohort.

Conclusion: In this older population with prior MI or IS, high rates of recurrent cardiovascular events and multiple recurrent events were observed. These findings highlight the need for aggressive intervention for secondary prevention and management of comorbidities in high-risk patients, particularly those with diabetes.

Keywords: Medicare; aging and the cardiovascular system; atherosclerotic cardiovascular disease; diabetes; recurrent event.

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Conflict of interest statement

All authors from the Chronic Disease Research Group, which is a program of the Hennepin Healthcare Research Institute, had full access to all study data and take responsibility for the integrity of data and the accuracy of data analysis. Drs Li, Peng, Guo, and Herzog, and Ms Wang are employees of the Chronic Disease Research Group, which is under contract with and has received funding from Amgen Inc. to conduct this research. Drs Qian, Xiang, and Lopez are employees and stockholders of Amgen Inc. Ms Wade reports consulting fees from Amgen Inc. Dr Herzog reports research grants from Amgen Inc. and ZOLL; consulting fees from AbbVie, FibroGen, Relypsa, OxThera, Sanifit, and ZS Pharma; royalties from UpToDate; stock at Merck; and employment at Hennepin Health System. Dr Handelsman reports research grants and consultant and speaker honoraria from Aegerion, Amarin, Amgen, AstraZeneca, Bristol‐Myers Squibb, Boehringer Ingelheim, Boehringer Ingelheim‐Lilly, Gan & Lee, Gilead, Grifols, Hanmi, Intarcia, Janssen, Lexicon, Lilly, Merck, Mylan, Merck‐Pfizer, Novo Nordisk, Regeneron, and Sanofi.

Figures

Figure 1
Figure 1
Cumulative incidence of cardiovascular events or death after index MI or IS: 2008 cohort. (A) MI cohort, (B) IS cohort, and (C) all‐cause death. CABG, coronary artery bypass grafting; IS, ischemic stroke; MI, myocardial infarction; PCI, percutaneous coronary intervention; UA, unstable angina
Figure 2
Figure 2
Adjusted risk ratios of outcomes associated with diabetes: 2012 (A) MI and (B) IS cohorts. CABG, coronary artery bypass grafting; IS, ischemic stroke; LCI, lower confidence interval; MI, myocardial infarction; PCI, percutaneous coronary intervention; RR, risk ratio; UA, unstable angina; UCI, upper confidence interval
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