International Variations in Case Fatality Following Major Coronary or Cerebrovascular Events in People With Type 2 Diabetes: Evidence From ADVANCE, TECOS, and EXSCEL

<p dir="ltr">OBJECTIVE: To examine differences in case-fatality incidence among people with type 2 diabetes after major coronary or cerebrovascular events by geographic region and by country income levels.</p><p dir="ltr">RESEARCH DESIGN AND METHODS: We studied ADVANCE, TECOS, and EXSCEL participants who experienced within-trial major coronary (fatal or nonfatal myocardial infarction or sudden cardiac death) or cerebrovascular (fatal or nonfatal stroke) events. Case fatality was defined as death at the time of, or within 30 days of, an event. We compared geographic regions to the reference category (Western Europe, North America, Australia and New Zealand) and compared medium- and low-income countries, based on gross national income per capita by the World Bank, with the reference category (high). Unadjusted and adjusted analyses were performed for each trial using logistic regression for individual participant data, and the results were meta-analyzed. Adjustments were made for previous cardiovascular events and risk factors. </p><p dir="ltr">RESULTS: There were 2574 major coronary and 1247 cerebrovascular events among the 40,563 study participants. Postcoronary case fatality adjusted odds ratios (95% CIs), compared with the reference group, were 3.31 (2.32–4.72), 2.78 (2.11–3.66), and 2.84 (1.71–4.73) for Asia, Central/Eastern Europe, and South America and Africa, respectively. The odds ratio for low/middle-income versus high-income countries was 3.07 (2.41–3.92). Case fatality following a major cerebrovascular event did not differ by geographic region or income group. </p><p dir="ltr">CONCLUSIONS: Postcoronary case fatality was substantially higher in Asia, Central/Eastern Europe, and South America/Africa compared with Western countries, and higher in low/middle-income countries compared with high-income countries.</p>