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Observational Study
. 2021 Jan 21;20(1):23.
doi: 10.1186/s12933-021-01212-x.

Ten-year cardiovascular risk in diabetes patients without obstructive coronary artery disease: a retrospective Western Denmark cohort study

Kevin Kris Warnakula Olesen  1   2   3 , Morten Madsen  4 , Christine Gyldenkerne  5 , Pernille Gro Thrane  5 , Troels Thim  5 , Lisette Okkels Jensen  6 , Hans Erik Bøtker  5 , Henrik Toft Sørensen  4 , Michael Maeng  5
Affiliations
Observational Study

Ten-year cardiovascular risk in diabetes patients without obstructive coronary artery disease: a retrospective Western Denmark cohort study

Kevin Kris Warnakula Olesen et al. Cardiovasc Diabetol. .

Abstract

Background: Diabetes patients without obstructive coronary artery disease as assessed by coronary angiography have a low risk of myocardial infarction, but their myocardial infarction risk may still be higher than the general population. We examined the 10-year risks of myocardial infarction, ischemic stroke, and death in diabetes patients without obstructive coronary artery disease according to coronary angiography, compared to risks in a matched general population cohort.

Methods: We included all diabetes patients without obstructive coronary artery disease examined by coronary angiography from 2003 to 2016 in Western Denmark. Patients were matched by age and sex with a cohort from the Western Denmark general population without a previous myocardial infarction or coronary revascularization. Outcomes were myocardial infarction, ischemic stroke, and death. Ten-year cumulative incidences were computed. Adjusted hazard ratios (HR) then were computed using stratified Cox regression with the general population as reference.

Results: We identified 5734 diabetes patients without obstructive coronary artery disease and 28,670 matched individuals from the general population. Median follow-up was 7 years. Diabetes patients without obstructive coronary artery disease had an almost similar 10-year risk of myocardial infarction (3.2% vs 2.9%, adjusted HR 0.93, 95% CI 0.72-1.20) compared to the general population, but had an increased risk of ischemic stroke (5.2% vs 2.2%, adjusted HR 1.87, 95% CI 1.47-2.38) and death (29.6% vs 17.8%, adjusted HR 1.24, 95% CI 1.13-1.36).

Conclusions: Patients with diabetes and no obstructive coronary artery disease have a 10-year risk of myocardial infarction that is similar to that found in the general population. However, they still remain at increased risk of ischemic stroke and death.

Keywords: Coronary angiography; Coronary artery disease; Death; Diabetes; Ischemic stroke; Myocardial infarction.

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Conflict of interest statement

Dr. Olesen has received a speaking fee from Bayer. Dr. Thrane, Dr. Gyldenkerne, Dr. Thim, and Professor Bøtker have no conflicts of interest. Mr. Madsen and Professor Sørensen has not received any personal fees, grants, travel grants, or teaching grants from companies. Department of Clinical Epidemiology is, however, involved in studies with funding from various companies as research grants to and administered by Aarhus University. None of these studies are related to the current study. Professor Jensen has received unrestricted grants to Department of Cardiology Odense University Hospital from Biotronik and Biosensors. Dr. Maeng has received advisory board fees from Boehringer-Ingelheim, AstraZeneca, Novo Nordisk, BMS, Boston Scientific, and Bayer.

Figures

Fig. 1
Fig. 1
Patient selection
Fig. 2
Fig. 2
Ten-year cumulative incidence proportion of myocardial infarction, ischemic stroke, and death in patients with diabetes and a matched general population comparison cohort. The curves for myocardial infarction and ischemic stroke were adjusted for competing risk of death
Fig. 3
Fig. 3
Stratified analysis by sex, clinical presentation, type of diabetes treatment, and diabetes duration. The hazard ratios (HR) denotes the risk as compared to a matched general population comparison cohort
See this image and copyright information in PMC

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