Key result
In women with ACS, diabetes was associated with higher in-hospital mortality (7.4% vs 3.6%; adjusted OR 2.13, 95% CI 1.39-3.26), whereas no significant increase was seen in men.
Why the study?
Does diabetes mellitus differentially affect clinical presentation and in-hospital mortality in men versus women with acute coronary syndromes?
Cohort (n=9,297)
Yes
Does diabetes mellitus differentially affect clinical presentation and in-hospital mortality in men versus women with acute coronary syndromes?
Odds Ratio: 2.13 (95% CI 1.39–3.26)
Absolute Event Rate: 7.4% vs 3.6%
p-value: p=0.021 for diabetes-sex interaction
Diabetes confers a significantly higher risk of ST-elevation presentation, Q-wave MI, and in-hospital mortality in women with ACS compared to men, highlighting a critical sex-specific interaction.
May warrant closer monitoring of diabetic women with ACS; hypothesis-generating for sex-specific diabetes effects on ACS mortality.
AIMS: To study clinical presentation, in-hospital course and short-term prognosis in men and women with diabetes mellitus and acute coronary syndromes (ACS). METHODS: Men (n = 6488, 21.2% with diabetes) and 2809 women (28.7% with diabetes) < or = 80 years old, with a discharge diagnosis of ACS were prospectively enrolled in the Euro Heart Survey of ACS. RESULTS: Women with diabetes were more likely to present with ST elevation than non-diabetic women, a difference that became more marked after adjustment for differences in smoking, hypertension, obesity, medication and prior disease [adjusted odds ratio (OR) 1.46 (1.20, 1.78)], whereas there was little difference between diabetic and non-diabetic men [adjusted OR 0.99 (0.86, 1.14)]. In addition, women with diabetes were more likely to develop Q-wave myocardial infarction (MI) than non-diabetic women [adjusted OR 1.61 (1.30, 1.99)], while there was no difference between men with and without diabetes [adjusted OR 0.99 (0.85, 1.15)]. There were significant interactions between sex, diabetes and presenting with ST-elevation ACS (P < 0.001), and Q-wave MI (P < 0.001), respectively. Of the women with diabetes, 7.4% died in hospital, compared with 3.6% of non-diabetic women [adjusted OR 2.13 (1.39, 3.26)], whereas corresponding mortality rates in men with and without diabetes were 4.1% and 3.3%, respectively [OR 1.13 (0.76, 1.67)] (P for diabetes-sex interaction 0.021). CONCLUSION: In women with ACS, diabetes is associated with higher risk of presenting with ST-elevation ACS, developing Q-wave MI, and of in-hospital mortality, whereas in men with ACS diabetes is not significantly associated with increased risk of either. These findings suggest a differential effect of diabetes on the pathophysiology of ACS based on the patient's sex.
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Dotevall et al. (2005) conducted a cohort in Acute coronary syndromes (n=9,297). Diabetes mellitus vs. No diabetes mellitus was evaluated on In-hospital mortality in women (adjusted OR 2.13, 95% CI 1.39-3.26, p=0.021 for diabetes-sex interaction). In women with ACS, diabetes was associated with higher in-hospital mortality (7.4% vs 3.6%; adjusted OR 2.13, 95% CI 1.39-3.26), whereas no significant increase was seen in men.
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