International Variation in Case Fatality After Major Coronary or Cerebrovascular Events in Individuals With Type 2 Diabetes: Evidence From ADVANCE, TECOS, and EXSCEL

OBJECTIVE To examine differences in case-fatality incidence among individuals with type 2 diabetes after major coronary or cerebrovascular events by geographic region and country income level. 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 or within 30 days of an event. We compared geographic regions with the reference category (Western Europe, North America, or 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. RESULTS There were 2,574 major coronary and 1,247 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 and Eastern Europe, and South America and Africa, respectively. The odds ratio for low- and middle-income versus high-income countries was 3.07 (2.41–3.92). Case fatality after a major cerebrovascular event did not differ by geographic region or income group. CONCLUSIONS Postcoronary case fatality was substantially higher in Asia, Central and Eastern Europe, and South America and Africa compared with Western countries and higher in low- and middle-income countries compared with high-income countries.