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European Heart Journal Advance Access published online on September 29, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp377
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Incidence and predictors of silent myocardial infarction in type 2 diabetes and the effect of fenofibrate: an analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

David C. Burgess1,*, David Hunt2, LiPing Li1, Diana Zannino1, Elizabeth Williamson1, Timothy M.E. Davis3, Markku Laakso4, Y. Antero Kesäniemi5, Jun Zhang1, Raymond W. Sy6, Seppo Lehto4, Stewart Mann7 and Anthony C. Keech1,*

1 NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia
2 Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
3 School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Fremantle, WA, Australia
4 Department of Medicine, University of Kuopio, Kuopio, Finland
5 Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
6 University of Sydney, NSW, Australia
7 Department of Medicine, University of Otago Wellington, Wellington, New Zealand

Received 18 February 2009; revised 27 July 2009; accepted 20 August 2009 * Corresponding authors. Tel: +61 2 9562 5000, Fax: +61 2 9562 5304, Email: fieldtrial{at}ctc.usyd.edu.au

Aims: To determine the incidence and predictors of, and effects of fenofibrate on silent myocardial infarction (MI) in a large contemporary cohort of patients with type 2 diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.

Methods and results: Routine electrocardiograms taken throughout the study were assessed by Minnesota-code criteria for the presence of new Q-waves without clinical presentation and analysed with blinding to treatment allocation and clinical outcome. Of all MIs, 36.8% were silent. Being male, older age, longer diabetes duration, prior cardiovascular disease (CVD), neuropathy, higher HbA1c, albuminuria, high serum creatinine, and insulin use all significantly predicted risk of clinical or silent MI. Fenofibrate reduced MI (clinical or silent) by 19% [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69–0.94; P = 0.006], non-fatal clinical MI by 24% (P = 0.01), and silent MI by 16% (P = 0.16). Among those having silent MI, fenofibrate reduced subsequent clinical CVD events by 78% (HR 0.22, 95% CI 0.08–0.65; P = 0.003).

Conclusion: Silent and clinical MI have similar risk factors and increase the risk of future CVD events. Fenofibrate reduces the risk of a first MI and substantially reduces the risk of further clinical CVD events after silent MI, supporting its use in type 2 diabetes.

Key Words: Silent myocardial infarction • Type 2 diabetes • Fenofibrate


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