MI risk in diabetes varies based on CAD
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Among patients with diabetes, risk for MI was elevated in those with CAD, but not in those without it, according to a poster presented at the European Society of Cardiology Congress.
The findings were simultaneously published in Diabetes and Vascular Disease Research.
“Diabetes patients without CAD by coronary angiography or coronary CTA have a low risk of MI, not substantially increased compared to patients with neither CAD nor diabetes,” Christine Gyldenkerne, MD, of the department of cardiology at Aarhus University Hospital, Denmark, and colleagues wrote in the simultaneous publication. “In the current evaluation with prolonged follow-up, we found that diabetes patients, commonly believed to have an increased risk of MI due to accelerated atherosclerosis, remained at low risk of MI for at least an 11-year period if they had no or mild CAD at the baseline evaluation. Diabetes patients with CAD, however, continued to have a much higher risk than patients with CAD alone. Thus, a single imaging assessment of the coronary arteries provides risk stratification that extends out to 11-year follow-up, even in an assumed high-risk diabetes population.”
The investigators conducted a registry-based cohort study of 86,202 western Denmark residents (median follow-up, 8.8 years) to determine the risk for MI among patients with and without diabetes, stratified by the presence of CAD.
In this cohort, 36.1% of patients had neither CAD nor diabetes, 4.7% had diabetes alone, 49.2% had CAD alone and 10% had CAD and diabetes.
Among the control group of patients with neither diabetes nor CAD, the cumulative incidence of MI was 2.6% (95% CI, 2.4-2.7).
Compared with individuals with neither diabetes nor CAD, investigators observed increased risk for MI among each subgroup:
- patients with diabetes and no CAD (HR = 1.2; 95% CI, 1-1.45);
- patients with CAD and no diabetes (HR = 2.75; 95% CI, 2.52-3.01); and
- patients with both CAD and diabetes (HR = 3.79; 95% CI, 3.43-4.2).
However, according to the researchers, although the 11-year RR for MI in patients with diabetes and no CAD was significant compared with patients without diabetes or CAD, the absolute risk difference was only 0.05% per year, which is not clinically relevant.
“In addition, diabetes also adversely affects the microvasculature in multiple organs leading to complications such as kidney failure and peripheral neuropathy,” the researchers wrote in the simultaneous publication. “Thus, the absence of CAD by coronary angiography ensures an 11-year low risk of MI for diabetes patients, but it only provides moderate protection against macrovascular complications, such as stroke and possibly peripheral artery disease, which could explain the observed increased mortality in diabetes patients. Furthermore, microvascular complications, particularly kidney failure, are strongly associated with mortality.”
In an interview with Healio, Gyldenkerne said these findings must be validated through further research before guidance for prophylactic strategies can be changed.
“Firstly, we aim to confirm the current results with long-term results based on our cardiac CT angiography cohort,” Gyldenkerne told Healio. “Secondly, our results suggest that screening for CAD may be used to differentiate diabetes patients with and without increased risk of CV events and guide prophylactic strategies. However, this concept warrants validation in prospective randomized trials.”
Reference:
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Gyldenkerne C, et al. Coronary artery disease (chronic) ePosters. Presented at: European Society of Cardiology Congress; Aug. 29-Sept. 1, 2020 (virtual meeting).
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