Gender differences in clinical outcomes among diabetic patients hospitalized for cardiovascular disease.
Gender differences in clinical outcomes among diabetic patients hospitalized for cardiovascular disease.
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DOI：
10.1016/j.ahj.2013.02.024
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发表时间：
2013-06
影响因子：
4.8
通讯作者：
Mosca, Lori
中科院分区：
文献类型：
--
作者：
Flink, Laura;Mochari-Greenberger, Heidi;Mosca, Lori
女性糖尿病患者发生心血管疾病的风险高于男性，但因心血管疾病住院的糖尿病患者临床结局的性别差异尚未确定。我们的目的是确定HbA 1c是否与30天和1年CVD再住院以及因CVD住院的糖尿病患者的总死亡率相关，总体和性别。这是一项对因CVD住院的糖尿病患者的前瞻性分析，这些患者参加了NHLBI赞助的观察性临床结局研究（N=902，女性39%，少数民族53%，平均年龄67±12岁）。实验室，再住院和死亡率数据由医院电子病历确定。血糖控制不良定义为HbA 1c ≥ 7%。使用logistic回归评价HbA 1c与临床结局之间的关联;通过交互作用项和分层模型评价性别调整。HbA 1c ≥7%的患病率为63%（n=566），性别相似。HbA1c≥ 7% vs.在单变量（OR=1.63;95%CI=1.05-2.54）和多变量校正模型（OR=1.74;95%CI =1.06-2.84）中，<7%与30天CVD再住院增加相关。血糖控制和性别之间存在相互作用，导致30天心血管疾病再住院风险（p=0.005）。在分层单变量模型中，女性中的相关性显著（OR=4.83;95%CI=1.84-12.71），但男性中的相关性不显著（OR=1.02;95%CI=0.60-1.71）。HbA 1c ≥ 7%的多变量校正风险与<7%的女性为8.50（95%CI=2.31-31.27），男性为1.02（95%CI=0.57-1.80）。HbA 1c <6%与≥6%的男性和女性相比，观察到30天/1年死亡风险增加的趋势。HbA 1c ≥ 7%的糖尿病女性因CVD住院，30天CVD再住院的风险是<7%;在男性中未观察到相关性。HbA 1c <6%的30天/1年死亡风险增加的趋势值得进一步研究。
The risk of incident CVD has been shown to be greater among diabetic women than men but gender differences in clinical outcomes among diabetics hospitalized with CVD is not established. We aimed to determine if HbA1c was associated with 30-day and 1-year CVD rehospitalization, and total mortality among diabetics hospitalized for CVD, overall and by gender. This was a prospective analysis of diabetic patients hospitalized for CVD, enrolled in an NHLBI-sponsored observational clinical outcomes study (N=902, 39%female, 53%racial/ethnic minority, mean age 67±12 years). Laboratory, rehospitalization and mortality data were determined by hospital-based electronic medical record. Poor glycemic control was defined as HbA1c≥7%. The association between HbA1c and clinical outcomes was evaluated using logistic regression; gender modification was evaluated by interaction terms and stratified models. HbA1c≥7% prevalence was 63%(n=566) and was similar by gender. HbA1c≥7%vs.<7% was associated with increased 30-day CVD rehospitalization in univariate (OR=1.63;95%CI=1.05–2.54), and multivariable-adjusted models (OR=1.74;95%CI=1.06–2.84). There was an interaction between glycemic control and gender for 30-day CVD rehospitalization risk (p=0.005). In stratified univariate models, the association was significant among women (OR=4.83;95%CI=1.84–12.71), but not among men (OR=1.02;95%CI=0.60–1.71). The multivariate adjusted risk for HbA1c≥ 7%vs.<7% among women was 8.50(95%CI=2.31–31.27) and 1.02(95%CI=0.57–1.80) for men. A trend toward increased 30-day/1-year mortality risk was observed for HbA1c<6%vs.≥6% for men and women. Risk of 30-day CVD rehospitalization was 8.5-fold higher among diabetic women hospitalized for CVD with HbA1c≥7%vs.<7%; no association was observed among men. A trend for increased 30-day/1-year mortality risk with HbA1c<6% deserves further study.
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影响因子：
105.7
作者：
Huxley, R;Barzi, F;Woodward, M
通讯作者：
Woodward, M
影响因子：
158.5
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
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120.7
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Berger, Jeffrey S.;Elliott, Laine;Gallup, Dianne;Roe, Matthew;Granger, Christopher B.;Armstrong, Paul W.;Simes, R. John;White, Harvey D.;Van de Werf, Frans;Topol, Eric J.;Hochman, Judith S.;Newby, L. Kristin;Harrington, Robert A.;Califf, Robert M.;Becker, Richard C.;Douglas, Pamela S.
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Douglas, Pamela S.
影响因子：
158.5
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通讯作者：
Califf, RM
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作者：
CHAN, P;PAN, WH
通讯作者：
PAN, WH