Impact of gender on prognosis in patients with acute myocardial infartion and diabetes

Introduction: Diabetes mellitus (DM) increases the risk of cardiovascular disease (CVD) by three to four times in women and two to three times in men. Women with diabetes lose their normal ‘female’ protection from CVD. Data from the Framingham cohort revealed that women with diabetes had a poorer outcome aft er myocardial infarction (AMI) than men. Few studies assessed long term outcomes aft er AMI in men and women with DM. Th e present study compares diabetic women with diabetic men in order to investigate whether there are any gender-related diff erences in long-term prognosis post AMI. Methods: Of 461 patients with acute myocardial infarction consecutively hospitalized in the Clinic of Cardiology during a two year period, 114 were diabetics, with a mean age 64.1 ± 0.9 years old, 56% men (M) and 44% women (W). We compared short and longterm AMI outcomes in men and women with diabetes mellitus (DM). Patients were followed-up aft er discharge for 56.4 ± 1.6 months. Th e following end-points were assessed: death of any cause, cardiovascular (CV) death, major advers cardiovascular events (non-fatal myocardial infarction, stroke, death). Results: W were older (p < 0.01), more oft en obeze (p < 0.01), had higher prevalence of heart failure (HF) (p < 0.01), LDL-colesterol and tryglicerides levels (p < 0.05), less oft en smoked (p < 0.001) vs M. Th ere were no sex related diff erence in DM duration, proportion of Q-/ non-Q wave AMI and its location. M has larger enzimatic infarction size (p < 0.05). W showed more oft en in-hospital HF progression (p < 0.05) and higher mortality vs M (p < 0.05). During follow-up W presented higher prevalence of HF NYHA class ≥ 3 (p < 0.01), MACE (p < 0.05), general and CV mortality (p < 0.01) vs M. By Cox regression analysis the best predictors of mortality aft er AMI were: women gender (HR = 1.88; 95% CI: 1.04 – 3.42, p < 0.05), HF history (HR = 3.49; 95% CI: 1.66 – 7.31, p < 0.01), Killip class > 2 (HR = 1.06; 95% CI: 1.07 – 14.8, p < 0.05). Conclusions: Diabetic women have a signifi cantly poorer short and long term AMI outcomes and a higher mortality compared to diabetic men. Greater awareness of this situation and strict multifactorial management have the potential to improve the unfavorable prognosis for diabetes women with AMI.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)