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Differing STEMI and NSTEMI profiles in type 1 diabetes underline need for CVD prevention

Author
Liam Andrew Davenport

medwireNews: In individuals with type 1 diabetes, ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) have distinct incidence patterns depending on age and occurrence of microvascular complications, reveals a Finnish study.

The research, published in The Lancet Diabetes & Endocrinology, indicates that a decreased estimated glomerular filtration rate (eGFR) is associated with STEMI, while NSTEMI is linked to severe diabetic retinopathy and kidney disease.

In an accompanying editorial, Angelo Avogaro and Gian Paolo Fadini, both from University of Padova in Italy, say that, despite several limitations, the analysis “provides one of the most granular contemporary assessments of myocardial infarction subtypes in type 1 diabetes.”

They write: “The message for clinicians is clear. Cardiovascular prevention in type 1 diabetes must begin early, be more comprehensive, and extend beyond glycaemia to encompass risk factor management and careful surveillance of microangiopathy and renal function.”

“Failure to adopt such an integrated approach will perpetuate the persistently high rates of NSTEMI observed in this study. Incorporating type 1 diabetes into a unified cardio–renal–metabolic framework is no longer optional but imperative for modern diabetes care.”

The researchers highlight that the Finnish Diabetic Nephropathy (FinnDiane) Study has previously shown that, in patients with longstanding type 1 diabetes, the cumulative incidence of coronary artery disease increases rapidly in those with a high prevalence of chronic microvascular complications, particularly diabetic kidney disease, versus those without microvascular complications.

To determine the incidence and risk profiles of STEMI and NSTEMI, the investigators studied 4215 adults with type 1 diabetes who were enrolled in the FinnDiane Study between November 1997 and December 2012 and had no history of MI or coronary revascularization.

The median age of the participants at baseline was 37 years and 52% were men. By December 2017, 449 incident MIs occurred, of which 19% were classified as STEMIs and 66% as NSTEMIs, with the remaining 15% having insufficient electrocardiogram data for classification, largely due to sudden death (71%).

The incidence of STEMI decreased from 142 cases per 100,000 person–years between 1997 and 2002 to 55 cases per 100,000 person–years between 2013 and 2017, whereas the incidence of NSTEMI initially decreased from 415 to 216 cases per 100,000 person–years between the periods of 1997–2002 and 2008–2012, and then rose to 280 cases per 100,000 person–years between 2013 and 2017.

Further research is needed to “ascertain whether this signifies a shift in diagnostics or is the consequence of the halt in diabetic kidney disease reduction that has previously been reported,” say Lena Thorn (University of Helsinki, Finland) and colleagues.

The overall 20-year cumulative incidence of all MIs on Fine and Gray competing risk analysis was 15.4%, 2.4% for STEMI, 10.9% for NSTEMI, and 1.8% for unclear MIs. There were no significant differences in the incidence between men and women but patients with severe albuminuria and kidney failure had a significantly increased risk for all types of MI.

Cox regression analysis revealed that a significantly increased risk for STEMI was independently associated with diabetes duration (hazard ratio [HR] per 10 years=1.84), higher glycated hemoglobin (HR=1.26 ), elevated systolic blood pressure (SBP; HR=1.13 per 10 mmHg), and peripheral arterial disease (HR=3.08), as well as a moderately decreased eGFR (30–59 mL/min per 1.73 m2, HR=3.36), severely decreased eGFR (15–29 mL/min per 1.73 m2, HR=4.26), and kidney failure (<15 mL/min per 1.73 m2, HR=3.52).

NSTEMI was also independently and significantly associated with diabetes duration (HR=2.26 per 10 years), higher glycated hemoglobin (HR=1.15), elevated SBP (HR=1.10 per 10 mmHg), and peripheral arterial disease (HR=2.03). In addition, NSTEMI was linked to increased low-density lipoprotein cholesterol (HR=1.22), lower high-density lipoprotein cholesterol (HR=0.59), previous stroke (HR=1.78), older age at diabetes onset (HR=1.28 per 5-year increase), and use of antidepressants (HR=1.93) and lipid-lowering medications (HR=1.40).

Finally, the researchers report that NSTEMI was additionally and significantly associated with severe albuminuria (HR=2.01), use of kidney replacement therapy (HR=3.65), and severe diabetic retinopathy (HR=1.49).

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2026 Springer Healthcare Ltd, part of Springer Nature

Lancet Diabetes Endocrinol 2026; doi:10.1016/S2213-8587(25)00368-7
Lancet Diabetes Endocrinol 2026; doi:10.1016/S2213-8587(25)00424-3


Raising the standard: ensuring patient safety through minimum requirements for CGM performance

Prof. Chantal Mathieu highlights how the absence of rigorous performance standards for continuous glucose monitors in Europe contributes to wide variability in device accuracy, raising important concerns about patient safety.

Supported by:
  • Abbott Diabetes Care
Prof. Chantal Mathieu
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Image Credits
Heart model and ECG representation/© Nataliia_Trushchenko / Generated with AI / Stock.adobe.com, Woman monitoring glucose level with sensor and an app on her phone while training at swimming pool/© (M) Goffkein, stock.adobe.com (symbolic image with model)