Incidence and prevalence of unrecognized myocardial infarction in people with diabetes: A substudy of the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of glycemia in Diabetes (RECORD) study

Objective: To examine the prevalence and incidence of unrecognized myocardial infarction in a contemporary population with type 2 diabetes. Research design and methods: We performed a retrospective analysis of the electrocardiograms (ECGs) recorded at baseline and after 2 years for the first 1,004 type 2 diabetic individuals to be randomized in the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) study. Results: ECGs suitable for analysis were obtained from 669 participants. The prevalence of unrecognized Q-wave myocardial infarction at baseline was 1.9% (n = 13). The incidence of unrecognized Q-wave myocardial infarction at the end of 2 years of follow-up was 1.5/1,000-person-years (n = 2). One-third (13 of 39) of prevalent and one-quarter (2 of 8) of incident myocardial infarctions were unrecognized. Conclusions: Although the prevalence and incidence of myocardial infarction was low, unrecognized Q-wave myocardial infarctions made up a substantial proportion of all events. Although usually accompanied by typical symptoms, some myocardial infarctions (MIs) are not clinically recognized. Unrecognized MIs are thought to be important because there is some evidence that they carry a similar prognosis to recognized MIs (1–3). People with diabetes are considered to be more at risk for unrecognized MIs than those without diabetes, but few data have directly addressed this issue. Consequently, we examined the prevalence and incidence of clinically unrecognized MI in a contemporary population with type 2 diabetes enrolled in the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) study.

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