Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015

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Abstract

Aims/hypothesis

The aim of the study was to examine trends in the incidence and case fatality of acute myocardial infarction (AMI) and in hospital admissions for angina and coronary revascularisation procedures in people with type 2 diabetes and in people without diabetes in Scotland between 2006 and 2015.

Methods

In this retrospective cohort study, AMI, angina and revascularisation event data were obtained for adults from hospital admissions and death records linked to a population-based diabetes register. Incidence by diabetes status was estimated using negative binomial models with adjustment or stratification by age, sex, deprivation and calendar year. Logistic regression was used to estimate AMI case fatality by diabetes status.

Results

There were 129,926 incident AMI events, 41,263 angina admissions and 69,875 coronary revascularisation procedures carried out during 34.9 million person-years of follow-up. The adjusted incidence of AMI, angina and revascularisation procedures declined by 2.0% (95% CI 1.73%, 2.26%), 9.62% (95% CI 9.22%, 10.01%) and 0.35% (95% CI −0.09%, 0.79%) per year, respectively. The rate of decline did not differ materially by diabetes status. RRs of AMI for type 2 diabetes were 1.86 (95% CI 1.74, 1.98) for men and 2.32 (95% CI 2.15, 2.51) for women. Of the 77,211 people admitted to hospital with a first AMI, 7842 (10.2%) died within 30 days of admission. Case fatality was higher in people with type 2 diabetes than in people without diabetes and declined in both groups by 7.93% (95% CI 7.03%, 8.82%) per year.

Conclusions/interpretation

The incidence of AMI, angina, revascularisation and AMI case fatality has declined over time, but the increased risk associated with type 2 diabetes has remained approximately constant.

Electronic supplementary material

The online version of this article (10.1007/s00125-018-4796-7) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Most cited references 14

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The Scottish Record Linkage System.

Hanna Clarke, Brent Kendrick (1993)

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Predictors and prognostic impact of recurrent myocardial infarction in patients with left ventricular dysfunction, heart failure, or both following a first myocardial infarction.

Jens Jakob Thune, James E. Signorovitch, Lars Kober … (2011)

IMS: Recurrent myocardial infarction (MI) is common after a first MI and is associated with increased morbidity and mortality. Predictors and prognosis of a recurrent MI with contemporary management are not well known.

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Is Open Access

Explaining trends in Scottish coronary heart disease mortality between 2000 and 2010 using IMPACTSEC model: retrospective analysis using routine data

Joel Hotchkiss, Carolyn A Davies, Ruth Dundas … (2014)

Objective To quantify the contributions of prevention and treatment to the trends in mortality due to coronary heart disease in Scotland. Design Retrospective analysis using IMPACTSEC, a previously validated policy model, to apportion the recent decline in coronary heart disease mortality to changes in major cardiovascular risk factors and to increases in more than 40 treatments in nine non-overlapping groups of patients. Setting Scotland. Participants All adults aged 25 years or over, stratified by sex, age group, and fifths of Scottish Index of Multiple Deprivation. Main outcome measure Deaths prevented or postponed. Results 5770 fewer deaths from coronary heart disease occurred in 2010 than would be expected if the 2000 mortality rates had persisted (8042 rather than 13 813). This reflected a 43% fall in coronary heart disease mortality rates (from 262 to 148 deaths per 100 000). Improved treatments accounted for approximately 43% (95% confidence interval 33% to 61%) of the fall in mortality, and this benefit was evenly distributed across deprivation fifths. Notable treatment contributions came from primary prevention for hypercholesterolaemia (13%), secondary prevention drugs (11%), and chronic angina treatments (7%). Risk factor improvements accounted for approximately 39% (28% to 49%) of the fall in mortality (44% in the most deprived fifth compared with only 36% in the most affluent fifth). Reductions in systolic blood pressure contributed more than one third (37%) of the decline in mortality, with no socioeconomic patterning. Smaller contributions came from falls in total cholesterol (9%), smoking (4%), and inactivity (2%). However, increases in obesity and diabetes offset some of these benefits, potentially increasing mortality by 4% and 8% respectively. Diabetes showed strong socioeconomic patterning (12% increase in the most deprived fifth compared with 5% for the most affluent fifth). Conclusions Increases in medical treatments accounted for almost half of the large recent decline in mortality due to coronary heart disease in Scotland. Furthermore, the Scottish National Health Service seems to have delivered these benefits equitably. However, the substantial contributions from population falls in blood pressure and other risk factors were diminished by adverse trends in obesity and diabetes. Additional population-wide interventions are urgently needed to reduce coronary heart disease mortality and inequalities in future decades.

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Author and article information

Contributors

Stephanie H. Read:

ORCID: http://orcid.org/0000-0002-2087-7358

Stephanie.Read@ed.ac.uk

Journal

Journal ID (nlm-ta): Diabetologia

Journal ID (iso-abbrev): Diabetologia

Title: Diabetologia

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0012-186X

ISSN (Electronic): 1432-0428

Publication date (Electronic): 17 January 2019

Publication date PMC-release: 17 January 2019

Publication date (Print): 2019

Volume: 62

Issue: 3

Pages: 418-425

Affiliations

[1 ]ISNI 0000 0004 1936 7988, GRID grid.4305.2, Usher Institute of Population Health Sciences and Informatics, , University of Edinburgh, ; Teviot Place, Edinburgh, EH8 9AG UK

[2 ]ISNI 0000 0004 0474 0188, GRID grid.417199.3, Women’s College Research Institute, Women’s College Hospital, ; Toronto, ON Canada

[3 ]ISNI 0000 0000 9506 6213, GRID grid.422655.2, Information Services Division, , NHS National Services Scotland, ; Edinburgh, UK

[4 ]Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK

[5 ]ISNI 0000 0004 1936 7857, GRID grid.1002.3, School of Public Health and Preventive Medicine, , Monash University, ; Melbourne, VIC Australia

[6 ]ISNI 0000 0001 2193 314X, GRID grid.8756.c, Institute of Health and Wellbeing, , University of Glasgow, ; Glasgow, UK

[7 ]ISNI 0000 0001 2193 314X, GRID grid.8756.c, Institute of Cardiovascular and Medical Sciences, , University of Glasgow, ; Glasgow, UK

Author information

Stephanie H. Read http://orcid.org/0000-0002-2087-7358

Article

Publisher ID: 4796

DOI: 10.1007/s00125-018-4796-7

PMC ID: 7019674

PubMed ID: 30656362

SO-VID: da427b2e-2ac3-40b8-9608-8538623bc6d2

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 7 September 2018

Date accepted : 27 November 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000589, Chief Scientist Office;

Award ID: PDF/15/07

Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;

Award ID: 201492/Z/16/Z

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: angina,coronary heart disease,myocardial infarction,revascularisation,type 2 diabetes

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: angina, coronary heart disease, myocardial infarction, revascularisation, type 2 diabetes

Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015

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Most cited references 14

The Scottish Record Linkage System.

Predictors and prognostic impact of recurrent myocardial infarction in patients with left ventricular dysfunction, heart failure, or both following a first myocardial infarction.

Explaining trends in Scottish coronary heart disease mortality between 2000 and 2010 using IMPACTSEC model: retrospective analysis using routine data

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