medwireNews: The presence of chronic kidney disease (CKD) has a large impact on the likelihood of people with type 1 diabetes dying after a myocardial infarction (MI), show findings from the FinnDiane Study.
“Prevention of CKD is consequently crucial to improve prognosis in individuals with type 1 diabetes both before and after an MI,” write Per-Henrik Groop (University of Helsinki, Finland) and study co-authors in Diabetes Care.
Even a moderately decreased estimated glomerular filtration rate (eGFR) of 30–59 mL/min per 1.73 m2 (grade 3) was associated with a significant 3.27-fold increased cardiovascular/diabetes-related mortality risk, relative to normal function, after accounting for factors including age, sex, diabetes duration, smoking status, glycated hemoglobin levels, and antihypertensive medication.
The risk increase was only slightly larger in people with more severe kidney dysfunction, at 3.62- and 4.03-fold with grade 4 and 5, respectively, which the researchers say is “in contrast to what we expected.”
They suggest there could be “some pre-MI survival bias in those with [grade 4] and [grade 5] eGFR that could explain this finding, but to explore this would warrant further studies.”
The analysis included data from 253 FinnDiane participants who had experienced a first MI, at an average age of 52.4 years, which the researchers note is younger than the average age at first MI in the general population. The overall survival after MI was 71.1% at 30 days, 62.1% at 1 year, and 42.1% after 5 years.
“The mortality within 30 days (29%) was comparable to population-based studies of individuals with and without diabetes but of clearly older age at MI,” observe Groop and colleagues.
Other factors besides eGFR that significantly increased the risk for post-MI mortality were older age at MI and a pre-existing coronary heart disease diagnosis. Undergoing acute or subacute revascularization were associated with a significantly reduced mortality risk.
“As a novel finding, we observed that the diabetes- and MI-related factors differed in their impact on our secondary outcomes, that is, recurrent MI, hospitalization due to heart failure, and coronary revascularization,” say the researchers.
The presence of CKD was associated with an increased risk for all three secondary outcomes. But this was the only significant predictor of heart failure, whereas revascularization and the presence of post-MI chest pain were associated with a reduced risk for the other two outcomes.
“Chest pain after an MI is, interestingly, a risk factor for recurrent MI in the general population,” say the study authors.
“This discrepancy could be due to chest pain being present in more severe coronary heart disease in the general population, whereas the lack of chest pain could be associated with cardiovascular autonomic neuropathy in type 1 diabetes.”
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