Risk Factors for Myocardial Infarction Case Fatality and Stroke Case Fatality in Type 2 Diabetes: UKPDS 66
Stevens RJ., Coleman RL., Adler AI., Stratton IM., Matthews DR., Holman RR.
OBJECTIVE - Patients with diabetes have a higher case fatality rate in myocardial infarction (MI) or stroke than those without diabetes: that is, MI and stroke are more often fatal if diabetes is present. We investigated whether the risk of MI or stroke being fatal in type 2 diabetes can be estimated using information available around the time diabetes is diagnosed. RESEARCH DESIGN AND METHODS - Analyses were based on 674 cases of MI (351 fatal) that occurred in 597 of 5,102 U.K. Prospective Diabetes Study (UKPDS) patients for whom covariate data were available during a median follow-up of 7 years. Multivariate logistic regression was used to examine differences in risk factors, measured within 2 years of diagnosis of diabetes, between fatal and nonfatal MI. Similar analyses were performed for 234 strokes (48 fatal) that occurred in 199 patients. RESULTS - Patients with fatal MI had higher HbA 1c , than those with nonfatal MI (odds ratio 1.17 per 1% HbA 1c , P = 0.014). Patients with fatal stroke had higher HbA 1c than those with nonfatal stroke (odds ratio 1.37 per 1% HbA 1c , P = 0.007). Other risk factors for MI case fatality included increased age, blood pressure, and urine albumin level. CONCLUSlONS - The risk of MI or stroke being fatal in type 2 diabetes is associated with risk factors, including HbA 1c , measured many years before onset of MI or stroke. Equations have been added to the UKPDS Risk Engine to estimate likely case fatality rates in MI and stroke.