Diabetes, hypertension, overweight and hyperlipidemia and 7-day case-fatality in first myocardial infarction

Out-of-hospital deaths due to a first myocardial infarction (MI) are frequent and a big challenge for prevention. Increased knowledge about factors influencing MI fatality is needed. Metabolic risk factors have been studied in relation to MI fatality in-hospital but studies considering also out-of-hospital deaths are few. To assess how diabetes and other metabolic risk factors associate with death within 7 days after first time MI among subjects aged between 45 and 70 identified in Stockholm County 1992–1994. Data were collected using questionnaires (close relatives of fatal cases were asked to fill the questionnaire), physical examinations, national registers and autopsy reports. Risk ratios (RR) of 7-day MI fatality with 95% confidence intervals (CI) associated with the risk factors under study were calculated using binomial regression with log link. Out of 1905 first time MI cases included, 524 died within 7 days. After adjustments for age, sex, current smoking, education and general comorbidity, diabetes, but not hypertension and hyperlipidemia, was associated with MI fatality (RR 1.68, 95% CI 1.20–2.28). Overweight, as compared to normal BMI, was inversely associated with MI fatality (multiple adjusted RR 0.68, 95% CI 0.49–0.94); obesity results pointed in the same direction (multiple adjusted RR 0.79, 0.52–1.16). In this population-based inception cohort study, diabetes but not hypertension and hyperlipidemia were associated with MI fatality. This further emphasizes the importance of diabetes as a cardiovascular risk factor and the need for close surveillance of diabetic patients. Overweight was however associated with decreased MI fatality.