| Prognostic Significance of Silent Myocardial Infarction in Newly-Diagnosed Type 2 Diabetes: UKPDS 79. | |
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MedLine Citation:
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PMID: 23362315 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: We aimed to determine the prevalence of silent myocardial infarction (SMI) in people with newly-diagnosed type 2 diabetes (T2D), and its relationship to future myocardial infarction (MI) and all-cause mortality. METHODS AND RESULTS: We examined data from the 5,102 patients in the 30-year UK Prospective Diabetes Study (UKPDS) and used Cox proportional hazards regression to examine outcomes by SMI status. Of 1,967 patients with complete baseline data, 326 (16.6%) had ECG evidence of SMI (Minnesota codes 1.1 or 1.2) at enrolment. Those with SMI were more likely to be older, female, sedentary and non-smokers 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 (95% CI) for those with, vs. those without, SMI in multivariate models that included UKPDS Risk Engine variables were 1.58 (1.22-2.05) for first fatal MI, and 1.31 (1.10-1.56) for all-cause mortality. Hazard ratios for first fatal or non-fatal MI, and for first non-fatal MI, were non-significant. The Net Reclassification Index showed no improvement when SMI was added to these models and the Integrated Discrimination Index showed that SMI marginally improved prediction of fatal MI and all-cause mortality. CONCLUSIONS: Around one in six UKPDS patients with newly-diagnosed T2D 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 INFORMATION: URL: http://www.controlled-trials.com. Identifier: ISRCTN number: 75451837. |
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Authors:
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Timothy M E Davis; Ruth Coleman; Rury R Holman |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2013-1-29 |
Journal Detail:
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Title: Circulation Volume: - ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2013 Jan |
Date Detail:
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Created Date: 2013-1-30 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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