Women younger than 65 years with diabetes mellitus are a high-risk group after myocardial infarction: a report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA)
Women younger than 65 years with diabetes mellitus are a high-risk group after myocardial infarction: a report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA)
复制标题
DOI：
10.1136/hrt.2007.135038
复制
发表时间：
2008-12-01
期刊：
影响因子：
5.7
通讯作者：
Wallentin, L.
中科院分区：
文献类型：
--
作者：
Norhammar, A.;Stenestrand, U.;Wallentin, L.
目的：分析性别差异的预后，危险因素和循证治疗糖尿病和心肌梗死患者。方法：在1995-2002年的死亡率进行了分析，在70 882瑞典患者（年龄，80）与第一注册记录急性心肌梗死分层的性别和年龄。由于死亡率的性别差异，特别是65岁以下患者的特征，因此在该25555例患者队列中进行了更详细的分析。在这一组中，5786人（23%）为女性，4473人（18%）患有糖尿病。临床和其他参数的差异进行了调整，使用倾向评分model.Results：长期死亡率在糖尿病患者年龄，65岁的女性显着高于男性（RR 1.34，95%CI 1.16至1.55）。与男性糖尿病患者相比，女性的风险因素负担增加（高血压49 vs 43%; RR 1.12; 95% CI 1.05 - 1.20;心力衰竭10 vs 8%; RR 1.25; 95% CI 1.03 - 1.53）。年龄65岁的糖尿病女性在急性住院期接受静脉β受体阻滞剂治疗的频率较低，出院时接受血管紧张素转换酶抑制剂治疗的频率较低。然而，这种使用不足与死亡率的差异，也不是女性性别本身。结论：65岁以下的女性糖尿病患者有一个较差的结果比男性心肌梗死后。这与风险因素负担增加有关。有人建议，提高对这种情况的认识和加强预防，有可能改善这些妇女的不利处境。
Objective: To analyse gender differences in prognosis, risk factors and evidence-based treatment in patients with diabetes and myocardial infarction.Methods: Mortality in 1995-2002 was analysed in 70 882 Swedish patients (age,80) with a first registry-recorded acute myocardial infarction stratified by gender and age. Owing to gender differences in mortality, specifically characterising patients below the age of 65 years, a more detailed analysis was performed within this cohort of 25 555 patients. In this group, 5786 (23%) were women and 4473 (18%) had diabetes. Differences in clinical and other parameters were adjusted for using a propensity score model.Results: Long-term mortality in diabetic patients aged,65 years was significantly higher in women than men (RR 1.34; 95% CI 1.16 to 1.55). Compared with diabetic men, women had an increased risk factor burden (hypertension 49 vs 43%; RR 1.12; 95% CI 1.05 to 1.20; heart failure 10 vs 8%; RR 1.25; 95% CI 1.03 to 1.53). Diabetic women aged,65 years were less frequently treated with intravenous beta-blockade during the acute hospital phase and with angiotensin-converting enzyme inhibitors at hospital discharge. However, this under-use was not associated with the mortality differences, nor was female gender by itself.Conclusion: Women below 65 years of age with diabetes have a poorer outcome than men after a myocardial infarction. This relates to an increased risk factor burden. It is suggested that greater awareness of this situation and improved prevention have the potential to improve what is an unfavourable situation for these women.