NEW YORK (Reuters Health) – Women younger than 65 with diabetes tend to have worse cardiovascular risk profiles than diabetic men of the same age, leading to higher mortality rates following an MI, analysis of data from a large Swedish registry indicate.
“The female advantage with fewer cardiovascular events than in men at younger ages is attenuated once a woman has the diagnosis of diabetes,” Dr. Anna Norhammar and associates write in the November issue of Heart. In fact, they add, “the risk is increased about twofold in men and up to four times in women.”
Their goal in the current study was to identify gender-related differences in prognosis, risk factors, or treatment among 25,555 patients below the age of 65 treated between 1995 and 2002 for MI. In this cohort, 23% were women; 21% of women and 16% of men were previously diagnosed with diabetes.
During a mean follow-up of 4.4 years, mortality was significantly greater among diabetic women in this age group than among diabetic men (relative risk 1.34).
Compared with the male patients, female patients had higher rates of hypertension and heart failure and were more likely to smoke.
Fewer women than men had undergone revascularization prior to their first MI, and women were less likely to be treated with intravenous beta-blockers and to be prescribed ACE inhibitors at discharge.
Nevertheless, Dr. Norhammar, at Karolinska University Hospital in Stockholm, and her team attribute the higher mortality to risk factors rather than treatment differences.
By contrast, there were no significant gender-related differences in mortality in older people, or among subjects without diabetes.
“The present observation makes further study of the impact of improved risk factor management in this particular group of relatively young, easily identifiable, high-risk patients important,” the authors conclude, “together with attempts to initiate treatment and cardiac investigations before their first myocardial infarction or the onset of heart failure.”
Reference:
Heart 2008;94:1565-1570.
