Incidence and prevalence of unrecognized myocardial infarction in people with diabetes: a substudy of the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) study
Michael R MacDonald, Mark C Petrie, Philip D Home, Michel Komajda, Nigel P Jones, Henning Beck-Nielsen, Ramon Gomis, Markolf Hanefeld, Stuart J Pocock, Paula S Curtis, John J V McMurray, Michael R MacDonald, Mark C Petrie, Philip D Home, Michel Komajda, Nigel P Jones, Henning Beck-Nielsen, Ramon Gomis, Markolf Hanefeld, Stuart J Pocock, Paula S Curtis, John J V McMurray
Abstract
Objective: To examine the prevalence and incidence of unrecognized myocardial infarction in a contemporary population with type 2 diabetes.
Research design and methods: We performed a retrospective analysis of the electrocardiograms (ECGs) recorded at baseline and after 2 years for the first 1,004 type 2 diabetic individuals to be randomized in the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) study.
Results: ECGs suitable for analysis were obtained from 669 participants. The prevalence of unrecognized Q-wave myocardial infarction at baseline was 1.9% (n = 13). The incidence of unrecognized Q-wave myocardial infarction at the end of 2 years of follow-up was 1.5/1,000-person-years (n = 2). One-third (13 of 39) of prevalent and one-quarter (2 of 8) of incident myocardial infarctions were unrecognized.
Conclusions: Although the prevalence and incidence of myocardial infarction was low, unrecognized Q-wave myocardial infarctions made up a substantial proportion of all events.
Trial registration: ClinicalTrials.gov NCT00379769.
References
- Sheifer SE, Gersh BJ, Yanez ND, 3rd, Ades PA, Burke GL, Manolio TA. Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly. J Am Coll Cardiol 2000;35:119–126
- Sigurdsson E, Thorgeirsson G, Sigvaldason H, Sigfusson N. Unrecognized myocardial infarction: epidemiology, clinical characteristics, and the prognostic role of angina pectoris. The Reykjavik Study. Ann Intern Med 1995;122:96–102
- Yano K, MacLean CJ. The incidence and prognosis of unrecognized myocardial infarction in the Honolulu, Hawaii, Heart Program. Arch Intern Med 1989;149:1528–1532
- Home PD, Pocock SJ, Beck-Nielsen H, et al. Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes (RECORD): study design and protocol. Diabetologia 2005;48:1726–1735
- Aguilar D, Goldhaber SZ, Gans DJ, et al. ; Collaborative Study Group Clinically unrecognized Q-wave myocardial infarction in patients with diabetes mellitus, systemic hypertension, and nephropathy. Am J Cardiol 2004;94:337–339
- Boland LL, Folsom AR, Sorlie PD, et al. Occurrence of unrecognized myocardial infarction in subjects aged 45 to 65 years (the ARIC study). Am J Cardiol 2002;90:927–931
- Davis TM, Fortun P, Mulder J, Davis WA, Bruce DG; Fremantle Diabetes Study Silent myocardial infarction and its prognosis in a community-based cohort of Type 2 diabetic patients: the Fremantle Diabetes Study. Diabetologia 2004;47:395–399
- Jónsdóttir LS, Sigfusson N, Sigvaldason H, Thorgeirsson G. Incidence and prevalence of recognised and unrecognised myocardial infarction in women. The Reykjavik Study. Eur Heart J 1998;19:1011–1018
- Nadelmann J, Frishman WH, Ooi WL, et al. Prevalence, incidence and prognosis of recognized and unrecognized myocardial infarction in persons aged 75 years or older: the Bronx Aging Study. Am J Cardiol 1990;66:533–537
- Dormandy JA, Charbonnel B, Eckland DJ, et al. ; PROactive investigators Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 2005;366:1279–1289
- Burgess DC, Hunt D, Li L, et al. Incidence and predictors of silent myocardial infarction in type 2 diabetes and the effect of fenofibrate: an analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Eur Heart J 2010;31:92–99
- Ammar KA, Kors JA, Yawn BP, Rodeheffer RJ. Defining unrecognized myocardial infarction: a call for standardized electrocardiographic diagnostic criteria. Am Heart J 2004;148:277–284
Source: PubMed