Diabetes mellitus as a contributor to the risk of acute myocardial infarction

doi:10.1016/S0895-4356(02)00486-9

Journal of Clinical Epidemiology

Volume 55, Issue 11, November 2002, Pages 1082-1087

https://doi.org/10.1016/S0895-4356(02)00486-9 Get rights and content

Abstract

The risk of nonfatal acute myocardial infarction (AMI) has been studied in relation to diabetes and other risk factors, combining data from three Italian case–control studies including 1,737 cases with nonfatal AMI and 2,317 controls in hospital for acute diseases unrelated to AMI risk factors. The multivariate odds ratio (OR) of AMI for diabetes was 2.3 (95% confidence interval, 1.8–2.9); the association with AMI risk was apparently stronger in patients diagnosed with diabetes when aged <40 years (OR 2.9), and in women (OR 4.4). When the combined effect of diabetes and other known risk factors on the risk of AMI was considered, compared to nondiabetic subjects with each factor at the lowest risk level, the OR for diabetic subjects was 4.7 in smokers, 2.8 in heavy coffee drinkers, 2.7 in those with higher body mass index, 3.4 in patients with high cholesterol levels, 3.3, 4.3, and 2.7 for diabetic subjects with history of hyperlipidemia, hypertension, and obesity, respectively, and 4.3 for those with a family history of AMI in first degree relatives. The association of each risk factor was much stronger in diabetic women. Preventive measures to reduce the prevalence of each additional risk factors in diabetic subjects could led to a substantial reduction of risk of AMI.

Introduction

Diabetes mellitus is a recognized risk factor for coronary heart disease 1, 2, 3, 4, 5, 6, 7, 8, the association being stronger in younger people 8, 9, 10, 11, 12 and in women 7, 8, 13.

Less information is available on the quantification of the risk of coronary heart disease in patients with diabetes simultaneously exposed to other risk factors, such as smoking, hypertension, hyperlipidemia, and obesity. A study, based on 582 cases of coronary heart diseases in diabetic subjects and 2,007 cases of coronary heart diseases in nondiabetic patients from the 1986 National Mortality Followback Survey, found that the relative risks of smoking and hypertension were similar in subjects with and without diabetes, while overweight showed a less strong association with coronary heart disease mortality in patients with diabetes than in those without diabetes [13]. A study conducted in Argentina on 1,060 patients with acute myocardial infarction (AMI) (164 of whom being also diabetic subjects), found an odds ratio (OR) of 2.0 for diabetes, and a multiplicative interaction of diabetes and smoking on the risk of AMI, leading to an OR of 9.3 [7]. Risk factors involved in the cardiometabolic syndrome in patients with diabetes include hypertension 14, 15, obesity (mainly central, i.e., high waist–hip ratio) 16, 17, atherosclerosis, dyslipidemia, hyperuricemia and endothelial dysfunction 14, 15. The Multiple Risk Factor Intervention Trial (MR-FIT), based on more than 5,000 patients with diabetes compared with 350,000 without diabetes followed for 12 years, found that systolic hypertension, elevated cholesterol levels, and cigarette smoking were independent predictors of cardiovascular mortality and that the presence of at least one of these risk factors had a greater absolute impact for increasing mortality in patients with diabetes than in those without diabetes [18].

To provide further quantitative information on the relation between diabetes and other recognized risk factors for coronary heart disease on the risk of AMI we have analyzed the results of a combined dataset from three case–control studies conducted in Italy.

Section snippets

Subjects and methods

Data were combined from three Italian hospital-based case–control studies of a first episode of nonfatal AMI (International Classification of Disease, ICD-9 410) [19]. The study designs have already been described in the original publications 3, 4, 20. The first study was conducted in northern Italy in 1983–1992 [3], and included 314 women with acute myocardial infarction (median age 50 years, range 18–74) and 733 female controls (median age 50 years, range 17–74). The second study was

Results

Table 1 gives the distribution of cases and controls in the overall dataset according to study, age, sex, and other selected covariates. Cases tended to be more frequently smokers and heavy coffee drinkers, to have higher BMI and serum cholesterol levels, and to report more frequently history of hyperlipidemia, hypertension, obesity, and AMI in first degree relatives.

A total of 221 (12.7%) cases (124 men and 97 women) vs. 150 (6.5%) controls (99 men and 51 women) reported history of diabetes,

Discussion

The results of this study indicate that people admitted to hospital with AMI have more than twice the risk of having diabetes than those admitted for unrelated reasons, confirming the results of other studies 9, 22, 23. We also found a stronger association in subjects diagnosed with diabetes when younger than 40 years, thus confirming the observations of a large case–control study from Argentina [7], and the results of a Swedish population-based cohort investigation of patients with diabetes

Acknowledgements

This article was partly supported by the Italian Ministry of Health (Contract n.177, RF 2001) and the Commission of the European Communities (Contract No. QLK1-CT-2000-00069).

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Original articleDiabetes mellitus as a contributor to the risk of acute myocardial infarction

Abstract

Introduction

Section snippets

Subjects and methods

Results

Discussion

Acknowledgements

Prev Med

J Clin Epidemiol

Ann Epidemiol

J Clin Epidemiol

Ann Epidemiol

Am J Med

J Clin Epidemiol

Diabetes and cardiovascular disease

The Framingham Study. JAMA

Mortality from coronary heart disease and stroke in relation to degree of glycaemiathe Whitehall Study

BMJ

Risk factors for myocardial infarction in young women

Am J Epidemiol

Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction

N Engl J Med

Coronary heart disease in patients with diabetes

N Engl J Med

Cause-specific mortality in a population-based study of diabetes

Am J Public Health

Original article
Diabetes mellitus as a contributor to the risk of acute myocardial infarction