BMJ Open. 2026 Sep 18;16(9):e121970. doi: 10.1136/bmjopen-2026-121970.
ABSTRACT
OBJECTIVES: This study aimed to assess cardiovascular (CV) risk across the full spectrum of dysglycaemia levels following myocardial infarction (MI).
DESIGN: Retrospective registry-based cohort study.
SETTING: All patients with MI in Sweden registered in the cardiac rehabilitation registry within the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) between 2006 and 2017.
PARTICIPANTS: In total, 47 558 patients over the age of 18 attending cardiac rehabilitation post-MI, with available information on glycaemic levels.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was major adverse CV events (MACE), a composite of all-cause mortality, MI and ischaemic stroke until the end of follow-up (30 June 2018). Secondary outcomes included all the components of MACE, CV mortality and hospitalisation for heart failure.
RESULTS: Pre-diabetes and possible diabetes were present in 20.6%, new-onset diabetes in 3.2% and known diabetes in 21.1%. During a median follow-up of 4.7 years, 9321 patients experienced MACE. A stepwise increase across glycaemic categories was observed, with HRs of 1.07 (95% CI 1.00 to 1.14) for pre-diabetes, 1.22 (95% CI 1.11 to 1.34) for possible diabetes, 1.22 (95% CI 1.08 to 1.37) for new-onset diabetes and 1.73 (95% CI 1.64 to 1.82) for known diabetes, compared with normoglycaemia. A near-linear association between fasting glucose and outcomes was observed across all patients, while glycated haemoglobin appears predictive mainly in those with established diabetes.
CONCLUSIONS: Glycaemic disturbances early after MI, including hyperglycaemia below the diagnostic threshold for diabetes, are associated with a progressively higher risk of adverse outcomes. Beyond routine screening, these findings support close follow-up of at-risk patients, irrespective of diabetes status.
PMID:42760071 | DOI:10.1136/bmjopen-2026-121970