Minerva

There’s worms in them thar hills . . . and other stories

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5973 (Published 09 October 2014) Cite this as: BMJ 2014;349:g5973

People with diabetes have a markedly increased risk of myocardial infarction, but a study from Australia shows that their risk relative to the population without diabetes has decreased there by nearly a half during 1998-2010 (Circuit Outcomes 2014, doi:10.1161/CIRCOUTCOMES.114.000952). The average annual decline of 3-5% applied to both sexes and to everyone over the age of 55, but unfortunately not at all below that age. As tighter glucose control in itself has little effect on myocardial infarction, most of the benefit must be coming from other sources. At present, the myocardial infarction risk of Australians with diabetes is still about 3-4 times that of the rest of the population.

Concerns have been expressed about the possible adverse cardiovascular effects of sulfonylurea drugs for diabetes for the past 40 years. It’s a measure of how little things have advanced that we are still having to pick up clues from cohort studies for lack of adequate randomised trials. In the …

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