American Diabetes Association
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Prognosis after first-ever myocardial infarction in type 1 diabetes is strongly affected by chronic kidney disease

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posted on 2022-11-18, 21:32 authored by Patrik Smidtslund, Fanny Jansson Sigfrids, Anni Ylinen, Nina Elonen, Valma Harjutsalo, Per-Henrik Groop, Lena M Thorn, FinnDiane Study Group

 

  

Objective: To study the prognosis after a first-ever myocardial infarction (MI) in type 1 diabetes, as well as how different MI- and diabetes-related factors affect the prognosis and risk of secondary cardiovascular events. 

Research Design and Methods: Observational follow-up study of 4,217 individuals from the Finnish Diabetic Nephropathy Study with no prior MI or coronary revascularization. We verified 253 (6.0%) MIs from medical records or death certificates. Mortality from cardiovascular or diabetes-related cause was our main endpoint, while hospitalization due to heart failure, coronary revascularization, and recurrent MI were secondary endpoints, while accounting for death as a competing risk.

Results: Of the individuals, 187 (73.9%) died during the median post-MI follow-up of 3.07 (IQR 0.02–8.45) years. Independent risk factors for cardiovascular and diabetes-related mortality were eGFR categories G3 (hazard ratio, HR 3.27 [confidence interval 1.76–6.08]), G4 (3.62 [1.69–7.73]), and G5 (4.03 [2.24–7.26]), prior coronary heart disease diagnosis (1.50 [1.03–2.20]), and older age at MI (1.03 [1.00–1.05]). Factors associated with lower mortality were acute revascularization (HR 0.35 [0.18–0.72]), and subacute revascularization (0.39 [0.26–0.59]). In Fine-Gray competing-risk analyses, kidney failure was associated with a higher risk of recurrent MI (subdistribution hazard ratio 3.27 [2.01–5.34]), heart failure (3.76 [2.46–5.76]), and coronary revascularization (3.04 [1.89–4.90]).

Conclusions: Individuals with type 1 diabetes have a high cardiovascular and diabetes-related mortality after their first-ever MI. Particularly poor kidney function is associated with high mortality and excessive risk of secondary cardiovascular events. 

Funding

Aarne Koskelon Säätiö

Diabetestutkimussäätiö

EVO governmental grants x TYH2018207

Finska Läkaresällskapet

Folkhälsanin Tutkimussäätiö

Liv och Hälsa Society

Novo Nordisk Fonden NNF OC0013659

Päivikki ja Sakari Sohlbergin Säätiö

Sigrid Juséliuksen Säätiö

Stiftelsen Dorothea Olivia, Karl Walter och Jarl Walter Perkléns Minne

Suomen Akatemia 316664

Wilhelm och Else Stockmanns Stiftelse

History