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Prognostic Significance of Silent Myocardial Infarction in Newly-Diagnosed Type 2 Diabetes: UKPDS 79.
MedLine Citation:
PMID:  23362315     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Timothy M E Davis; Ruth Coleman; Rury R Holman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-29
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia.
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