# Incidence of acute myocardial infarction in people with diabetes compared to those without diabetes: a systematic review

## TL;DR

People with diabetes have a higher risk of heart attacks than those without diabetes, but study results vary widely due to differences in populations and methods.

## Contribution

This systematic review compares AMI incidence in diabetic and non-diabetic populations and highlights inconsistencies in trends and definitions.

## Key findings

- AMI incidence in people with diabetes is significantly higher than in those without diabetes.
- The decline in AMI incidence over time is less consistent in people with diabetes compared to those without diabetes.
- Variations in study results are likely due to differences in population characteristics, geographic regions, and methodologies.

## Abstract

Although diabetes mellitus is an established risk factor for acute myocardial infarction (AMI), epidemiological studies showed wide variations in the incidence of AMI in people with diabetes and inconsistent time trends. The objectives of the present systematic review were as follows: (i) to analyze the age–sex-adjusted incidence of both non-fatal and fatal AMI in people with diabetes compared to those without diabetes, (ii) to investigate corresponding time trends, and (iii) to identify sex differences.

A systematic literature search was performed in the literature databases MEDLINE, Embase, and LILACS until July 19, 2023, to identify population-based studies reporting the incidence of AMI in people with diabetes compared to those without diabetes according to our predefined inclusion criteria.

In total, 28 population-based cohort studies were included in this review. In women with diabetes, the incidence of AMI ranged from 102 to 690 per 100,000 person-years, and in men with diabetes from 206 to 1630. Estimates comparing people with and without diabetes ranged from 1.55 (95% CI 1.44–1.67) to 14.37 (8.43–24.47) in women and from 1.33 (1.18–1.51) to 4.17 (2.72–6.37) in men. Over the past four decades, the incidence of AMI declined in almost all studies in people without diabetes, but only in half of the studies in people with diabetes. There was considerable heterogeneity with regard to the definition of AMI, the population with diabetes, and geographic differences.

Incidence of AMI in people with diabetes remained significantly higher than in those without diabetes. A reduction in the incidence of AMI over time was observed in some, but not all reviewed studies in people with diabetes. There was no discernible trend of estimates comparing people with and without diabetes. These findings underscore the necessity for additional initiatives to prevent coronary heart disease in people with diabetes. The observed discrepancy in study results is presumably attributable to variations in the population and regional contexts, as well as to disparate methodological approaches. More standardized studies employing comparable methodologies are therefore required.

PROSPERO CRD42 02014 5562

The online version contains supplementary material available at 10.1186/s13643-026-03089-x.