University of Oulu

Kiviniemi, A. M., Lepojärvi, E. S., Tulppo, M. P., Piira, O.-P., Kenttä, T. V., Perkiömäki, J. S., … Huikuri, H. V. (2019). Prediabetes and Risk for Cardiac Death Among Patients With Coronary Artery Disease: The ARTEMIS Study. Diabetes Care, 42(7), 1319–1325.

Prediabetes and risk for cardiac death among patients with coronary artery disease : the ARTEMIS study

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Author: Kiviniemi, Antti M.1; Lepojärvi, E. Samuli1; Tulppo, Mikko P.1;
Organizations: 1Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
2Division of Cardiology, Miller School of Medicine, University of Miami, Miami, FL
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: American Diabetes Association, 2019
Publish Date: 2019-11-18


Objective: To compare cardiac mortality in patients with CAD and prediabetes with that in CAD patients with normal glycemic status and type 2 diabetes.

Research design and methods: The Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study included patients with CAD after revascularization (79%), optimal medical therapy, or both. Patients had type 2 diabetes (n = 834), impaired glucose tolerance (IGT; n = 314), impaired fasting glucose (IFG; n = 103), or normal glycemic status (n = 697) as defined on the basis of the results of an oral glucose tolerance test. The primary end point was cardiac death. Major adverse cardiac event (MACE: cardiac death, heart failure, or acute coronary syndrome) and all-cause mortality were secondary end points.

Results: During a mean ± SD follow-up of 6.3 ± 1.6 years, 101 cardiac deaths, 385 MACEs, and 208 deaths occurred. Patients with IGT tended to have 49% lower adjusted risk for cardiac death (P = 0.069), 32% lower adjusted risk for all-cause mortality (P = 0.076), and 36% lower adjusted risk for MACE (P = 0.011) than patients with type 2 diabetes. The patients with IFG had 82% lower adjusted risk for all-cause mortality (P = 0.015) than the patients with type 2 diabetes, whereas risks for cardiac death and MACE did not differ significantly between the two groups. The adjusted risks for cardiac death, MACE, and all-cause mortality among patients with IGT and IFG did not significantly differ from those risks among patients with normal glycemic status.

Conclusions: Cardiac mortality or incidence of MACE in patients with CAD with prediabetes (i.e., IGT or IFG after revascularization, optimal medical therapy, or both) does not differ from those values in patients with normal glycemic status.

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Series: Diabetes care
ISSN: 0149-5992
ISSN-E: 1935-5548
ISSN-L: 0149-5992
Volume: 42
Issue: 7
Pages: 1319 - 1325
DOI: 10.2337/dc18-2549
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: The study was funded by the Finnish Technology Development Center (TEKES, Helsinki, Finland), the Academy of Finland (#267435, Helsinki, Finland), the Finnish Foundation for Cardiovascular Research (Helsinki, Finland) and the Paulo Foundation (Espoo, Finland). The authors appreciate the financial support received from the ARTEMIS consortium partners (Polar Electro, Kempele, Finland and Hur Oy, Kokkola, Finland). Dr. Myerburg is supported in part by the American Heart Association Chair in Cardiovascular Research at the University of Miami.
Academy of Finland Grant Number: 267435
Detailed Information: 267435 (Academy of Finland Funding decision)
Copyright information: © 2019 by the American Diabetes Association. This is an Accepted Manuscript of an article published in Diabetes Care. The Definitive Version of Record can be found online at: