Sex-specific trends in incidence of myocardial infarction among people with and without diabetes between 1985 and 2016 in a German region

Background The reduction of myocardial infarction (MI) and narrowing the gap between the populations with and without diabetes are important goals of diabetes care. We analyzed time trends of sex-specific incidence rates (IR) of first MI (all, non-fatal MI, fatal event) in the population with and without diabetes. Methods Using data from the KORA myocardial infarction registry (Augsburg, Germany), we estimated age-adjusted IR in people with and without diabetes, corresponding relative risks (RR), and time trends from 1985 to 2016 using Poisson regression. Results There were 19,683 people with MI (34% fatal events, 71% men, 30% with diabetes). In the entire study population, the IR of all MI decreased from 359(95% CI: 345–374) to 236(226–245) per 100,000 person years. In men with diabetes, IR decreased only in 2013–2016. This was due to non-fatal MI, where IR in men with diabetes increased until 2009–2012, and slightly decreased in 2013–2016. Overall, fatal events declined stronger than non-fatal MI corresponding to IRs, the relative risk (RR) of all MI substantially increased among men from 1.40(1.22–1.61) in 1985–1988 to 2.60(2.26–2.99) in 1997–2000 and moderately decreased in 2013–2016: RR: 1.75(1.47–2.09). Among women no consistent time trend of RR was observed. Time trends of RR were similar regarding non-fatal MI and fatal events. Conclusions Over the study period, we found a decreased incidence of all MIs and fatal events in the entire study population. The initial increase of non-fatal MIs in men with diabetes needs further research. The gap between populations with and without diabetes remained.