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CLINICAL RESEARCH: MYOCARDIAL INFARCTION

The Gender-Specific Impact of Diabetes and Myocardial Infarction at Baseline and During Follow-Up on Mortality From All Causes and Coronary Heart Disease

Gang Hu, MD, PhD^_*,,_*, Pekka Jousilahti, MD, PhD^_*,, Qing Qiao, MD, PhD^_*,, Markku Peltonen, PhD^_*,, Shuichi Katoh, MD, PhD^_*, and Jaakko Tuomilehto, MD, PhD^_*,

^_* Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
Department of Public Health, University of Helsinki, Helsinki, Finland
Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.

Manuscript received September 28, 2004; revised manuscript received January 13, 2005, accepted January 17, 2005.

^_* Reprint requests and correspondence: Dr. Gang Hu, Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland. (Email: hu.gang{at}ktl.fi).

OBJECTIVES: The goal of this study is to compare the magnitude of diabetes and myocardial infarction (MI) at baseline and during follow-up on cause-specific and all-cause mortality.

BACKGROUND: History of both MI and diabetes are strong predictors of coronary heart disease (CHD) death. However, gender-specific data on the joint effect of diabetes and MI, and particularly on the effect of incident diabetes and MI developed during the follow-up, on CHD mortality are scarce.

METHODS: The baseline cohort study included 2,416 patients with prior diabetes or MI at baseline; the follow-up cohort study included 4,315 patients with incident diabetes or MI diagnosed during the follow-up.

RESULTS: In the baseline cohort study, men with prior MI had a 20% to 80% increased risk of CHD or total mortality, but women with prior MI had a 43% to 45% decreased risk of CHD or total mortality in comparison with men and women with prior diabetes. In the follow-up cohort study, men and women with incident MI had a higher risk of CHD mortality (hazard ratio [HR] 2.15 in men and 1.65 in women), and an almost similar risk of total mortality (HR 0.95 in men and 1.02 in women) in comparison with men and women with incident diabetes.

CONCLUSIONS: In men, MI at baseline or during follow-up confers a greater risk on CHD mortality than diabetes does. In women, prior MI at baseline confers a lower risk on CHD mortality than prior diabetes does, but incident MI during follow-up confers a greater risk than incident diabetes does. In both men and women, total mortality is similar for incident MI and diabetes.

Abbreviations and Acronyms   BMI = body mass index   CHD = coronary heart disease   CI = confidence interval   CVD = cardiovascular disease   HR = hazard ratio   ICD = International Classification of Diseases   MI = myocardial infarction

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