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Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

The Relationship between Ischemic Heart Disease and Diabete: A population-based approach

Publikation: Bog/antologi/afhandling/rapportPh.d.-afhandlingForskning

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Vis graf over relationer
Diabetes is a well-established risk factor for cardiovascular disease and is common among patients with acute myocardial infarction (MI), where the prevalence is as high as 20%. Patients with diabetes requiring glucose-lowering medication (GLM) have been reported as having the same long-term risk of major cardiovascular outcomes as patients with a previous MI. Focus on the
adverse prognosis carried by diabetes in the post-MI patients has caused new guidelines to be developed recommending similar preventive strategies to reduce the risk in these patients.

Furthermore, heart failure is common after myocardial infarction and smaller studies have recently indicated that heart failure (HF) may be associated with insulin resistance. Nevertheless, larger scale studies investigating this topic are currently missing. Because of the adverse prognosis carried by patients with both diabetes and MI it is of great importance to explore the short and long-term risk of having these diseases and furthermore to investigate the extent to which
patients with MI develop diabetes in order to commence early and aggressive evidence based therapy providing long term benefit in these high risk patients.

THE PRESENT THESIS HAD THE FOLLOWING OBJECTIVES ON THE SUBJECT:
The relationship between ischemic heart disease and diabetes:

1. To examine the short- and long-term risk of death and cardiovascular outcomes in patients with incident diabetes and in patients with first-time MI during a 10 year period in Denmark, using the general population as a reference.

2. To investigate the temporal trends in initiation of GLM following discharge for first-time MI between 1997 and 2006.

3. To assess whether HF severity, as determined by loop diuretic dosages, predicts the risk of developing diabetes after myocardial infarction.

The thesis was based on national administrative registers. The registers primarily employed for this thesis were: The Danish Register of Medicinal Product Statistics (the National Prescription Register), the Danish National Patient Register, The Central Population Register and the Danish Causes of Death Register.

Patients admitted to the hospital with first-time MI or patients developing diabetes requiring GLM during the study period of 10 years (1. January 1997-31. December 2006) were included in the study.

THE THESIS REVEALED THE FOLLOWING MAIN RESULTS
1) Patients developing GLM requiring diabetes carried an approximately two-fold risk of death of all causes, cardiovascular death and MI immediately following initiation of GLM treatment, compared to the general population.

There was a high short-term risk of death, cardiovascular death and recurrent MI in the incident MI population with a rapid decline during the 1st year. No decline of relative risk was demonstrated when comparing the MI population in the two the time-periods 1997 to mid-2001and mid-2001 to 2006.

2) An increased incidence rate of GLM initiation within the first year following discharge for firsttime MI from the year 1997 until 2001. From 2001 and onwards the incidence rate stabilized. A similar trend was documented in the general population with an increased incidence rate from the year 1997 until 2004. Following 2004 the incidence rate stabilized.
A temporal shift in type of first initiated GLM to first-time MI patients was demonstrated. The use of metformin and insulin increased significantly during the study period. Correspondingly, the use of sulfonylurea declined.

3) Our study demonstrated a linear relationship between HF severity post-MI and risk of developing diabetes, with patients using loop diuretics > 120 mg/day carrying an approximately two-fold increase in risk of diabetes, compared to patients without HF. Incident diabetes was found to carry nearly a threefold increase in relative risk of death.

CONCLUSION:

1. Patients developing GLM requiring diabetes carry an approximately two-fold increased risk of cardiovascular death compared with the general population. Patients with first-time MI have a high short-term risk of cardiovascular death rapidly declining and nearly resembling the risk carried by the diabetes population.

2. Development of diabetes is frequent after first-time MI and probably under-diagnosed.

3. The risk of developing diabetes increases with increasing severity of heart failure.
Focus on the development of diabetes in patients with ischemic heart disease with or without the presence of heart failure still compose a public health matter, because early and aggressive evidence-based therapy is thought to reduce the morbidity of patients with diabetes thereby improving the prognosis for these patients.
OriginalsprogEngelsk
Udgivelses stedGentofte Hospital
Antal sider36
ISBN (Trykt)978-87-92010-18-6
StatusUdgivet - 12 feb. 2012

ID: 34696246