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The Finnish contribution to the World Health Organization Multinational Monitoring of Trends and Determinants of Cardiovascular Disease, FINMONICA, was different from most cardiologic studies in that it monitored prognosis from the beginning of symptoms, including out-of-hospital deaths, which occurred before admission to a hospital. In this study, mortality rates were again higher in diabetic men, who had a little more than a 50% 1-year case fatality rate, than in nondiabetic men, who had about a 35% 1-year case fatality rate. Mortality rates were also higher in diabetic women, who had a 45% case fatality rate, than in nondiabetic women, who had a 24% case fatality rate. However, the case fatality rate is higher in diabetic men than in diabetic women, which is somewhat unusual but can be understood by looking at when the deaths occurred. Time of death was divided into three periods: out-of-hospital deaths, deaths occurring within 28 days of hospitalization, and deaths occurring 28 days to 1 year after hospitalization. In diabetic men, out-of-hospital mortality was much higher than in diabetic women, suggesting that diabetic women may survive long enough to reach the hospital but then have much higher 28-day mortality. In fact, if out-of-hospital mortality is excluded, mortality rates from hospitalization to 1 year are higher in diabetic women than diabetic men, as was shown in the Minnesota Heart Study in the previous slide. Another interesting feature about the FINMONICA study is that it examined the prognosis of people having a first myocardial infarction. Given that diabetics have an increased rate of CHD and an increased case fatality rate, any diabetic who dies before reaching the hospital with a first myocardial infarction cannot possibly benefit from the secondary prevention program. This study was an important influence for the ADA's recommendation that perhaps all diabetics should be treated as if they have preexisting atherosclerosis. Reference: Miettinen H, Lehto S, Salomaa V, Mahonen M, Niemela M, Haffner SM, Pyorala K, Tuomilehto J, for the FINMONICA Myocardial Infarction Register Study Group. Impact of diabetes on mortality after the first myocardial infarction. Diabetes Care 1998;21:69-75.Website. Keywords: coronary heart disease, diabetes, FINMONICA Myocardial Infarction Register, mortality

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