Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease

Christine Gyldenkerne, Kevin Kris Warnakula Olesen, Morten Madsen, Troels Thim, Lisette Okkels Jensen, Bent Raungaard, Henrik Toft Sørensen, Hans Erik Bøtker, Michael Maeng

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Abstract

Objective: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. Methods: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. Results: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27–1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27–2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61–8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40–12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51–17.82). Conclusion: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.

Original languageEnglish
JournalDiabetes and Vascular Disease Research
Volume16
Issue number4
Pages (from-to)351-359
Number of pages9
ISSN1479-1641
DOIs
Publication statusPublished - Jul 2019

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Coronary Artery Disease
Myocardial Infarction
Confidence Intervals
Insulin
Diet
Therapeutics
Glucose
Coronary Angiography
Type 2 Diabetes Mellitus
Pathologic Constriction

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Gyldenkerne, Christine ; Olesen, Kevin Kris Warnakula ; Madsen, Morten ; Thim, Troels ; Jensen, Lisette Okkels ; Raungaard, Bent ; Sørensen, Henrik Toft ; Bøtker, Hans Erik ; Maeng, Michael. / Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease. In: Diabetes and Vascular Disease Research. 2019 ; Vol. 16, No. 4. pp. 351-359.
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abstract = "Objective: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. Methods: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50{\%}) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. Results: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95{\%} confidence interval 0.27–1.81) and insulin (adjusted hazard ratio 0.76, 95{\%} confidence interval 0.27–2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95{\%} confidence interval 1.61–8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95{\%} confidence interval 2.40–12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95{\%} confidence interval 3.51–17.82). Conclusion: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.",
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Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease. / Gyldenkerne, Christine; Olesen, Kevin Kris Warnakula; Madsen, Morten; Thim, Troels; Jensen, Lisette Okkels; Raungaard, Bent; Sørensen, Henrik Toft; Bøtker, Hans Erik; Maeng, Michael.

In: Diabetes and Vascular Disease Research, Vol. 16, No. 4, 07.2019, p. 351-359.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease

AU - Gyldenkerne, Christine

AU - Olesen, Kevin Kris Warnakula

AU - Madsen, Morten

AU - Thim, Troels

AU - Jensen, Lisette Okkels

AU - Raungaard, Bent

AU - Sørensen, Henrik Toft

AU - Bøtker, Hans Erik

AU - Maeng, Michael

PY - 2019/7

Y1 - 2019/7

N2 - Objective: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. Methods: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. Results: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27–1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27–2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61–8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40–12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51–17.82). Conclusion: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.

AB - Objective: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. Methods: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. Results: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27–1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27–2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61–8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40–12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51–17.82). Conclusion: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.

U2 - 10.1177/1479164119836227

DO - 10.1177/1479164119836227

M3 - Journal article

C2 - 30939916

VL - 16

SP - 351

EP - 359

JO - Diabetes and Vascular Disease Research

JF - Diabetes and Vascular Disease Research

SN - 1479-1641

IS - 4

ER -