Jakob Starup-Linde, Jan Scheel-Thomsen, Michael Gejl, Peter Vestergaard, and Soeren Gregersen
Objective: Type 2 Diabetes Mellitus (DM) is associated with an increased risk of cardiovascular events. Glycemic control is beneficial to reduce acute myocardial infarction (AMI), however little is known whether a specific antidiabetic treatment is superior to another. This study aims at examining antidiabetic drugs and their association with a subsequent AMI in patients with DM.
Methods: A nested case-control study was conducted. Cases were patients with DM who subsequently suffered from AMI; controls were DM patients with no subsequent AMI after DM diagnosis. Using the Danish National Hospital Discharge Register, we included DM patients with information on date of DM diagnosis, date of AMI, and comorbidities. From the Central Region of Jutland, Denmark, medication use and biochemical parameters were collected. Multivariate logistic regression analyses were conducted.
Results: 10,727 DM patients were included. In multivariate analysis liraglutide (OR= 0.386, 95%CI 0.218-0.682) decreased the risk of AMI. An AMI prior to DM diagnosis (OR=36.004, 95%CI: 24.441-53.038), increasing age (1.027, 95%CI 1.016-1.039), increasing diabetes duration (1.060, 95%CI 1.043-1.077), male gender (OR=1.310, 95%CI 1.025-1.676), a diagnosis of heart failure (OR=2.083, 95%CI: 1.459-2.973), and peripheral artery disease (OR=1.506, 95%CI: 1.032-2.198) were all significantly associated with the risk of subsequent AMI. Neither insulin, β- cell stimulans, biguanides, antihypertensive treatment nor usage of statins or antiarrhythmic drugs showed any significance. When additional adjustment by biochemical risk markers was done insulin was significantly associated with a reduced risk of AMI (OR=0.235, 95%CI 0.073-0.757). .Furthermore, liraglutide and biguanides both showed a significant dose- and exposure time effects on OR for AMI.
Conclusion: We have found a strong association between the use of liraglutide and insulin, and a reduced risk of AMI in patients with DM when taking general risk factors into account.