Abstract 16007: Community-Based Trends in Acute Coronary Syndrome Incidence in Diabetic and Non-Diabetic Patients From 2008-2011: The Kaiser Permanente ACS Study
Background: Differences in recent population trends for the incidence of acute coronary syndrome (ACS) in patients with and without diabetes mellitus (DM) has not been well described.
Methods: We identified patients >=18 years old with and without DM (based on relevant diagnoses and/or medication use) hospitalized with ACS between 2008 and 2011 within Kaiser Permanente Northern California, a large, integrated health care delivery system caring for ~3.3 million persons. Hospitalized ACS was defined as either acute myocardial infarction (MI) (ICD-9 code 410.x) or unstable angina (ICD-9 code 411.x) with an elevated cardiac troponin I. We calculated incidence per 100,000 person-years (p-y) for ACS overall and separately for ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) by DM status. Trends in events per calendar year by DM status were examined using Poisson regression.
Results: Overall event rates for ACS (per 100,000 p-y) were substantially higher for patients with DM compared to those without DM, but declined in both groups between 2008-2011 (905 to 796 for DM; 166 to 138 for no DM) (P<0.01 for all linear trends). The majority of STEMIs in the overall population were concentrated among DM patients, with slight reductions over time for those with DM (124 to 106) (P=0.032) and without DM (38 to 35) (P=0.045). Similarly, NSTEMIs were disproportionately higher in patients with DM, with reductions observed in both groups during the study period (781 to 690 for DM, P=0.02; 128 to 103 for non-DM, P<0.001) (Figure).
Conclusions: The contemporary incidence of ACS, STEMI, and NSTEMI was markedly higher in patients with DM compared to those without DM in a large, diverse community-based population, and reductions in event rates were observed for both patient populations from 2008-2011. Despite recent improvements in primary prevention, additional efforts are needed to further reduce the risk of ACS among the growing number of patients with diabetes mellitus.
- Acute coronary syndromes
- Myocardial infarction, NSTEMI
- Myocardial infarction, STEMI
- © 2013 by American Heart Association, Inc.