Regional Variations in Case Fatality following a Major Coronary or Cerebrovascular Event in People with Type 2 Diabetes—Evidence from the ADVANCE Trial and TECOS Trial
Authors: CLARKE PHILIP M. , HUA XINYANG , CHALMERS JOHN , WOODWARD MARK , COLEMAN RUTH L. , GREEN JENNIFER B. , MCGUIRE DARREN K. , HOLMAN RURY R. 
Published: June 2018

Objective: To explore possible differences in case fatality after a major coronary (fatal or non-fatal MI, sudden death) or cerebrovascular (fatal of non-fatal stroke) event in different regions of the world according to country’s geographical region and income level.
Method: We studied ADVANCE and TECOS participants who experienced a major coronary or cerebrovascular event during these two trials, with countries grouped by: 1) Geographical region; 2) World Bank income levels and examined all-cause mortality that occurred within 30 days after the event. We used logistic regression to derive odds ratios for fatal events, controlling for previous complications and for a range of clinical risk factors.
Results: Both studies showed that people from Asia and Central/Eastern Europe (compared with the reference group of Western Europe, North America, Australia and New Zealand), and people from low and middle income countries (compared with those from high income countries), had significantly higher odds of dying within 30 days after a major coronary event but not a major cerebrovascular event (Table).
Adjusted Odds Ratio (95% CI)* for case fatalityADVANCETECOSPost major coronary eventBy geographic regionAsia†3.13 (1.89-5.19)**3.82 (2.06-7.07)**Central & Eastern EU†3.31 (2.00-5.49)**2.59 (1.54-4.33)**By income groupLow and middle income countries#3.22 (2.13-4.88)**3.07 (1.95-4.83)**Post major cerebrovascular eventBy geographic regionAsia†0.46 (0.20-1.03)0.76 (0.25-2.32)Central & Eastern EU†0.82 (0.37-1.86)1.26 (0.52-3.05)By income groupLow and middle income countries#0.61 (0.30-1.22)1.67 (0.72-3.68)*Controlling for age, gender, duration of diabetes, hemoglobin A1c, systolic blood pressure, body mass index, total cholesterol/ high-density lipoproteins, smoking, drinking, previous events (MI, stroke, heart failure, atrial fibrillation)† Compared to Western Europe, North America, Australia and New Zealand# Compared to people from high income countries **P&lt;0.01
Conclusion: There are regional and income variations in all-cause mortality in people with type 2 diabetes following major coronary but not cerebrovascular events, which could be a result of disparities in emergency systems and MI treatments.

Disclosure
P.M. Clarke: None. X. Hua: None. J. Chalmers: Research Support; Self; Servier. Other Relationship; Self; Servier. M. Woodward: None. R.L. Coleman: None. J.B. Green: Consultant; Self; Merck Sharp & Dohme Corp.. Research Support; Self; AstraZeneca. Consultant; Self; Daiichi Sankyo Company, Limited. Research Support; Self; GlaxoSmithKline plc., Intarcia Therapeutics, Inc.. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc. D.K. McGuire: Consultant; Self; AstraZeneca, Sanofi-Aventis, Eli Lilly and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc., Pfizer Inc., Novo Nordisk A/S. Research Support; Self; AstraZeneca, Sanofi-Aventis, Janssen Pharmaceuticals, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, Lexicon Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Esperion Therapeutics. R.R. Holman: Research Support; Self; AstraZeneca, Merck & Co., Inc., Bayer AG. Advisory Panel; Self; Elcelyx Therapeutics, Inc., Novartis AG, Novo Nordisk A/S. Other Relationship; Self; Bayer AG. Advisory Panel; Self; Merck & Co., Inc.. Other Relationship; Self; AstraZeneca.