Sex differences in the prognostic importance of diabetes in patients with ischemic heart disease undergoing coronary angiography
Sex differences in the prognostic importance of diabetes in patients with ischemic heart disease undergoing coronary angiography
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DOI：
10.2337/diacare.26.11.3142
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发表时间：
2003-11-01
期刊：
影响因子：
16.2
通讯作者：
Knudtson, ML
中科院分区：
文献类型：
--
作者：
Graham, MM;Ghali, WA;Knudtson, ML
目的--患有缺血性心脏病的女性预后比男性差，并被认为与糖尿病相关的风险更高。在按性别分层的分析中，我们评估了与糖尿病相关的预后，以确定是否在大量未选定的患者中看到了类似的差异。研究设计和方法-使用阿尔伯塔省冠心病结局评估项目(方法)，一个临床数据收集和跟踪倡议，捕获了加拿大阿尔伯塔省所有接受心导管术的患者，评估了13,152名男性和4,249名女性中糖尿病对长期生存的相对意义，这些患者有或没有出现心肌梗死，并根据接受的第一次治疗。非糖尿病和糖尿病男性分别为0.001%、4.1%和7.4%(P<；0.001)，非糖尿病和糖尿病女性分别为5.8%和9.6%(P<；0.001)。风险调整后的COX比例风险比与糖尿病相关的心肌梗死男性为1.03，女性为1.20。经皮冠状动脉介入治疗的糖尿病风险比男性为1.28，女性为1.40，搭桥术为1.23，女性为1.32，内科治疗为男性1.26，女性1.31(男女糖尿病风险比比较P=NS)。结论女性冠状动脉造影术患者糖尿病相关不良预后的量化危险比始终高于男性，但性别差异无统计学意义。在入路注册中注意到的这些微小的性别差异与以前报道的结果相似，可能在临床上很重要。
OBJECTIVE - Women with ischemic heart disease have poorer outcomes than men and are suggested to have greater risk associated with diabetes. We evaluated the prognosis associated with diabetes, in analyses stratified by sex, to determine whether similar differences,are seen in a large unselected cohort of patients.RESEARCH DESIGN AND METHODS - Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), a clinical data collection and follow-up initiative capturing all patients undergoing cardiac catheterization in Alberta, Canada, the relative significance of diabetes on long-term survival in 13,152 men and 4,249 women was evaluated in patients presenting with or without myocardial infarction and according to first treatment received.RESULTS - The 1-year mortality rates were 4.7% and 6.8% in men and women (P < 0.001), 4.1% and 7.4% innondiabetic and diabetic men (P < 0.001), and 5.8% and 9.6% in nondiabetic and diabetic women, respectively (P < 0.001). The risk-adjusted Cox proportional hazard ratios associated with diabetes in myocardial infarction were 1.03 in men and 1.20 in women. The diabetes hazard ratios for percutaneous coronary intervention were 1.28 in men and 1.40 in women, 1.23 in men and 1.32 in women for bypass surgery, and 1.26 in men and 1.31 in women for medical therapy (P = NS for all diabetes hazard ratio comparisons between men and women).CONCLUSIONS - Hazard ratios quantifying the adverse prognosis associated with diabetes in patients undergoing angiography are consistently higher among women than men, but the differences across sexes are not statistically significant. These slight sex differences noted in the APPROACH registry are similar to previously reported findings and may be clinically important.