Myocardial infarction subtypes in type 1 diabetes follow different patterns and have different risk profiles
Individuals living with type 1 diabetes face a significantly elevated risk of myocardial infarction, but not all myocardial infarctions are alike. A new study shows that the two main subtypes, STEMI and NSTEMI, behave differently over time and are driven by distinct combinations of risk factors. Understanding these differences could help clinicians better tailor prevention strategies for individuals with type 1 diabetes.
Cardiovascular disease is a leading cause of death among people with type 1 diabetes, yet detailed data on specific myocardial infarction subtypes in this population have been scarce. Researchers from the FinnDiane Study set out to fill this gap by examining incidence patterns and what factors predict them.
The study followed 4215 adults with type 1 diabetes across Finland, drawing on medical records and death certificates to identify and confirm myocardial infarctions. Between 1997 and 2017, nearly one in six participants experienced a myocardial infarction. NSTEMI, the type often presenting with a partial coronary occlusion, was nearly five times more common than STEMI, which involves a sudden, complete blockage of a coronary artery.
The findings revealed striking differences between the two subtypes. STEMI rates declined over time, consistent with broader improvements in cardiovascular care. NSTEMI rates, however, rose after an initial decline and became more prevalent with older age. The two subtypes also had different risk profiles: factors such as diabetic retinopathy and albuminuria-based diabetic kidney disease were linked to NSTEMI but not STEMI. Reduced kidney filtration capacity, on the other hand, was specifically associated with higher STEMI risk. Longer diabetes duration, suboptimal blood sugar control, and cigarette smoking increased the risk of both myocardial infarction subtypes. Sex did not affect the risk of any myocardial infarction subtype.
These results call for a broader view of diabetes complications in clinical practice. Microvascular disease should be recognized not only as a marker of kidney or eye dysfunction, but also as a signal of heightened vulnerability to NSTEMI. Cardiovascular risk assessment in type 1 diabetes needs to start early, be applied equally regardless of sex, and encompass the full range of complications the disease can bring.
– It was striking to see that while STEMI rates have declined over the years, likely reflecting advances in cardiovascular care, the incidence of NSTEMI failed to decline. This is a clear signal that we still have significant work to in protecting people with type 1 diabetes from cardiovascular disease, says author Patrik Smidtslund.
Original article:
Comparison of incidence patterns and risk profiles of ST-elevation and non-ST-elevation myocardial infarction in type 1 diabetes in Finland: a nationwide cohort study.
Smidtslund P, Harjutsalo V, Thorn V et al. The Lancet Diabetes & Endocrinology, 2026.