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Original research article
Glycaemic control and excess risk of major coronary events in patients with type 2 diabetes: a population-based study
  1. Mauro Tancredi1,2,
  2. Annika Rosengren1,
  3. Ann-Marie Svensson1,3,
  4. Aldina Pivodic4,5,
  5. Soffia Gudbjörnsdottir1,
  6. Hans Wedel6 and
  7. Marcus Lind1,2
  1. 1Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
  2. 2Department of Medicine, NU-Hospital Organization, Trollhättan and Uddevalla, Sweden
  3. 3Centre of Registers in region Västra Götaland, Gothenburg, Sweden
  4. 4Statistiska Konsultgruppen, Gothenburg, Sweden
  5. 5Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  6. 6Health Metrics Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Dr Mauro Tancredi; mautanc{at}


Objective The purpose of the study was to investigate the excess risk of acute myocardial infarction (AMI) and death from coronary artery disease (coronary heart disease, CHD) in relation to age, level of glycaemic control and renal complications in patients with type 2 diabetes.

Methods A total of 431 579 patients with type 2 diabetes mellitus registered in the Swedish National Diabetes Register from 1 January 1998 to 31 December 2012, and 2 173 620 controls from the general population were included. Cox regression was used to study the excess risk of AMI and CHD.

Results During follow-up of 5.1 years in the diabetes group and 5.4 years in the control group, 36 124 (8.4%) and 115 712 (5.3%) CHD events were registered, with corresponding incidence rates/1000 person-years of 14.64 (95% CI 14.49 to 14.79) and 8.73 (95% CI 8.68 to 8.78), respectively. The HR after adjustment for sex and age was 1.67 (1.65–1.69) which was reduced to 1.42 (1.41–1.44) with further adjustment for level of education, country of birth, diabetes duration and comorbidities. The multivariable-adjusted HR for AMI and CHD death with a time-updated glycated haemoglobin level of 6.9% or lower (≤52 mmol/mol) together with normoalbuminuria and estimated glomerular filtration rate ≥60 mL/min for patients with diabetes compared with controls was 0.95 (95% CI 0.92 to 0.98, p<0.001).

Conclusions In this study, the excess risk of AMI and CHD death was higher for patients with type 2 diabetes compared with controls but converged to that in the general population in patients with on-target HbA1c levels and without renal complications.

  • diabetes mellitus
  • myocardial infarction
  • coronary artery disease
  • cardiovascular disease
  • renal complications

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  • Contributors MT and ML drafted the manuscript, with AR revising it for important intellectual content. AP performed the statistical analysis. SG and AMS contributed to data collection. All authors contributed to the study design, data interpretation and to manuscript drafting and approval. ML is the guarantor of this work and, as such, had full access to all data in the study and takes responsibility for the integrity of data and accuracy of the analysis.

  • Funding The study was financed by grants from the Swedish Society of Medicine and the Health and Medical Care Committee of the Regional Executive Board, Region Västra Götaland, Sweden, the Swedish State under the Agreement Concerning Research and Education of Doctors; the Swedish Heart and Lung Foundation; and the Swedish Research Council (SIMSAM).

  • Competing interests None declared.

    ML has received honoraria or been consultant for Astra Zeneca, DexCom, Eli Lilly, MSD, Rubin Medical and Novonordisk and received research grants from Astra Zeneca, DexCom and Novonordisk.

  • Patient consent for publication Not required.

  • Ethics approval Regional Ethics Review Board at University of Gothenburg, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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