Key result
Known diabetes is linked to ~73% higher MACE risk post-MI compared to normoglycaemia.
Why the study?
Cardiovascular risk across the full spectrum of dysglycaemia levels following myocardial infarction was not well characterized.
Does dysglycaemia increase the risk of major adverse cardiovascular events in patients post-myocardial infarction?
Cohort (n=47,558)
Yes
Does dysglycaemia increase the risk of major adverse cardiovascular events in patients post-myocardial infarction?
Even mild glycaemic disturbances below the diagnostic threshold for diabetes are associated with a progressively higher risk of adverse cardiovascular outcomes after myocardial infarction.
Objectives This study aimed to assess cardiovascular (CV) risk across the full spectrum of dysglycaemia levels following myocardial infarction (MI). Design Retrospective registry-based cohort study. Setting All patients with MI in Sweden registered in the cardiac rehabilitation registry within the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) between 2006 and 2017. Participants In total, 47 558 patients over the age of 18 attending cardiac rehabilitation post-MI, with available information on glycaemic levels. Primary and secondary outcome measures The primary outcome was major adverse CV events (MACE), a composite of all-cause mortality, MI and ischaemic stroke until the end of follow-up (30 June 2018). Secondary outcomes included all the components of MACE, CV mortality and hospitalisation for heart failure. Results Pre-diabetes and possible diabetes were present in 20.6%, new-onset diabetes in 3.2% and known diabetes in 21.1%. During a median follow-up of 4.7 years, 9321 patients experienced MACE. A stepwise increase across glycaemic categories was observed, with HRs of 1.07 (95% CI 1.00 to 1.14) for pre-diabetes, 1.22 (95% CI 1.11 to 1.34) for possible diabetes, 1.22 (95% CI 1.08 to 1.37) for new-onset diabetes and 1.73 (95% CI 1.64 to 1.82) for known diabetes, compared with normoglycaemia. A near-linear association between fasting glucose and outcomes was observed across all patients, while glycated haemoglobin appears predictive mainly in those with established diabetes. Conclusions Glycaemic disturbances early after MI, including hyperglycaemia below the diagnostic threshold for diabetes, are associated with a progressively higher risk of adverse outcomes. Beyond routine screening, these findings support close follow-up of at-risk patients, irrespective of diabetes status.
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Haider et al. (2026) conducted a cohort in Myocardial infarction (n=47,558). Dysglycaemia (pre-diabetes, possible diabetes, new-onset diabetes, known diabetes) vs. Normoglycaemia (normal glucose level) was evaluated on Major adverse CV events (MACE), a composite of all-cause mortality, MI and ischaemic stroke (HR 1.73, 95% CI 1.64-1.82). Known diabetes was associated with a higher risk of major adverse cardiovascular events (HR 1.73) compared to normoglycaemia, with a stepwise risk increase across all dysglycaemia categories.
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