Sex-related disparities in prognosis and clinical progression in patients with type 2 diabetes and degenerative aortic stenosis

Abstract Background/Introduction There is accumulating evidence indicating sex-related disparities in aortic stenosis (AS) regarding time to diagnosis, type of symptoms, cardiac adaptations to increased afterload, and prognosis after different types of valve replacement interventions. However, studies investigating these differences are limited1-4 and have inconsistent results, limiting the possibility of drawing firm conclusions. Purpose To investigate sex-based differences in prognosis (all-cause and cardiovascular mortality) and clinical progression among individuals with type 2 diabetes and AS. Clinical progression was defined as the time from AS diagnosis to the occurrence of a composite outcome, including death, aortic valve replacement (AVR), or hospitalization for heart failure. Methods We used the Swedish National Diabetes Register (NDR) to identify individuals with type 2 diabetes diagnosed with incident AS between 2001–2019. We linked NDR with several Swedish health and administrative registries to collect data on AS diagnosis and comorbidities using International Classification of Diseases, 10th Revision codes, as well as education and income data. The primary outcome was all-cause mortality (acquired from the Swedish Cause of Death Registry), and the secondary outcome was a composite of mortality, hospitalization for heart failure, and AVR. Kaplan-Meier curves were used to compare outcomes between men and women. Cox proportional hazards models were applied to adjust the comparison for possible confounding factors. Results Among the 16,116 individuals with type 2 diabetes and AS, 9,473 were men and 6,643 were women. The mean age was 71 years; men were younger than women, had a higher prevalence of comorbidities, and exhibited type 2 diabetes with more complications. Unadjusted all-cause mortality was higher in women, whereas clinical progression did not significantly differ between sexes (Figure 1). Of the separate outcomes, men had earlier intervention procedures (TAVR/SAVR), while women had a more rapid progress to heart failure. After adjusting for age, education, comorbidities, and medication, men were 13% more likely to die (HR = 1.13, 95% CI = 1.07–1.19) and had a 15% higher risk (HR = 1.15, 95% CI = 1.10–1.21) of experiencing the composite outcome compared to women. The factors that correlated with the composite outcome are presented in figure 2 and were largely the same for men and women. Conclusions Among individuals with type 2 diabetes and degenerative AS, men exhibit higher all-cause mortality and faster disease progression, leading to increased risk of death, AVR, or hospitalization for heart failure compared to women.Kaplan Meier curves men-women Factors correlated with composite outcom