Abstract 16876: Changes in Population Attributable Fraction of Acute Coronary Syndrome Due to Diabetes in Finland During 1992 - 2002
Introduction: Acute coronary syndrome (ACS) event rates are decreasing in many countries, mainly due to better control of risk factors. At the same time, the prevalence of diabetes is increasing. Diabetes is known to almost double the risk of an ACS event, but the net effect of these conflicting developments on the population attributable fraction (PAF) of ACS events due to diabetes is not known.
Hypothesis: We hypothesized that the PAF of ACS events due to diabetes has increased.
Methods: We used comprehensive country-wide health care registers linked together with the personal identification code to identify all persons aged 25-80 years treated for diabetes in Finland during the period 1992-2002. Their data were further linked to the national cardiovascular disease register to identify the first ACS events among the diabetic and non-diabetic persons in the country for the same time period. Annual population counts were obtained from the National Population Information System. We calculated annual PAF (95% confidence intervals) of ACS due to diabetes separately for men and women. PAF was calculated according to the formula PAF = (Pe*(RR-1)/(1+(Pe*(RR-1)))*100, where RR is the risk ratio and Pe is the estimate of population exposure. Trends for PAF were estimated by using log-linear regression models with year as an independent variable.
Results: The number of men treated for diabetes almost doubled during the study period from 37,073 to 69,158. Among women, the increase was from 42,485 to 57,372. The number of first ACS events in the country declined among men from 10,211 to 9,406 and among women from 5,626 to 4,796 per year. PAF increased among men from 11.6 % (10.9 - 12.3 %) to 15.0 % (14.2 - 15.8 %), p for trend <0.0001. Among women, PAF declined slightly and nonsignificantly from 22.0 % (20.9 - 23.2 %) to 20.6 % (19.4 - 21.8 %), p for trend 0.10. The trends in PAF were significantly different between the genders (p<0.001 for the year by gender interaction).
Conclusions: PAF of first ACS due to diabetes increased among men and tended to decrease among women during 1992 - 2002 in Finland. As a whole, the contribution of diabetes to the burden of first ACS was considerable and, despite the different developments between the genders, remained clearly higher in women than in men.
- © 2010 by American Heart Association, Inc.