Prognostic Significance of Silent Myocardial Infarction in Newly Diagnosed Type 2 Diabetes Mellitus
Open Access
- 5 March 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 127 (9), 980-987
- https://doi.org/10.1161/circulationaha.112.000908
Abstract
Background—We aimed to determine the prevalence of silent myocardial infarction (SMI) in people with newly diagnosed type 2 diabetes mellitus and its relationships to future myocardial infarction (MI) and all-cause mortality. Methods and Results—We examined data from the 5102 patients in the 30-year UK Prospective Diabetes Study (UKPDS) and used Cox proportional hazards regression to examine outcomes by SMI status. Of 1967 patients with complete baseline data, 326 (16.6%) had ECG evidence of SMI (Minnesota codes 1.1 or 1.2) at enrollment. Those with SMI were more likely to be older, female, sedentary, and nonsmokers compared with those without SMI. Their mean blood pressure was greater despite more intensive antihypertensive treatment; they were more likely to be taking aspirin and lipid-lowering therapy; and they had a greater prevalence of microangiopathy. Fully adjusted hazard ratios for those with versus those without SMI in multivariate models that included UKPDS Risk Engine variables were 1.58 (95% confidence interval, 1.22–2.05) for fatal MI and 1.31 (95% confidence interval, 1.10–1.56) for all-cause mortality. Hazard ratios for first fatal or nonfatal MI and for first nonfatal MI were nonsignificant. The net reclassification index showed no improvement when SMI was added to these models, and the integrated discrimination index showed that SMI marginally improved the prediction of fatal MI and all-cause mortality. Conclusions—About 1 in 6 UKPDS patients with newly diagnosed type 2 diabetes mellitus had evidence of SMI, which was independently associated with an increased risk of fatal MI and all-cause mortality. However, identification of SMI does not add substantively to current UKPDS Risk Engine predictive variables. Clinical Trial Registration—URL: http://www.controlled-trials.com. Identifier: ISRCTN number 75451837.This publication has 30 references indexed in Scilit:
- Incidence and Prevalence of Unrecognized Myocardial Infarction in People With DiabetesDiabetes Care, 2011
- Incidence and predictors of silent myocardial infarction in type 2 diabetes and the effect of fenofibrate: an analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) studyEuropean Heart Journal, 2009
- 10-Year Follow-up of Intensive Glucose Control in Type 2 DiabetesThe New England Journal of Medicine, 2008
- The accuracy of electrocardiographic Q waves for the detection of prior myocardial infarction as assessed by a novel standard of referenceClinical Cardiology, 2004
- Percutaneous coronary intervention. I: History and developmentBMJ, 2003
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)The Lancet, 1998
- Natural history of isolated bundle branch blockThe American Journal of Cardiology, 1996
- Prevalence, incidence and prognosis of recognized and unrecognized myocardial infarction in persons aged 75 years or older: The Bronx Aging StudyThe American Journal of Cardiology, 1990
- Unrecognized myocardial infarction and hypertension: The Framingham StudyAmerican Heart Journal, 1985
- Incidence and Prognosis of Unrecognized Myocardial InfarctionThe New England Journal of Medicine, 1984