Women with diabetes at higher risk for acute MI than men

Women with diabetes are more likely than men with diabetes to experience acute myocardial infarction, with a “risk window” that increases just before menopause, according to study findings presented at the 51st European Association for the Study of Diabetes Annual Meeting.

“Women have a higher excess risk of [MI] than their male diabetic counterparts,” Giuseppe Seghieri, MD, an epidemiologist with the Regional Health Agency of Tuscany and the Study Center of Gender Medicine and Health of the ASL 3 in Pistoia, Italy, told Endocrine Today. “This is probably due to the fact that women come later to the diagnosis of diabetes, are undertreated as to drugs used in the secondary prevention of [cardiovascular disease] and reach fewer targets than men for lipemic control, metabolic control and blood pressure control.”

Giuseppe Seghieri

Seghieri and colleagues analyzed data from the general population registry of all residents of Tuscany (n=3,192,203; 47% men), as well as hospital discharge data from all Tuscan hospitals between 2005 and 2012 and data from a registry of all known patients with diabetes in Tuscany. Researchers measured the effect of diabetes on hospitalization for MI, stroke and congestive heart failure separately in men and women using Cox regression analysis.

Within the cohort, there were 24,605 hospitalizations for acute MI (16,251 men), 26,953 for stroke (14,848 men) and 17,628 for congestive heart failure (8,403 men). After adjusting for age, women with diabetes had a significantly higher risk than men with diabetes for acute MI (HR = 2.63; 95% CI, 2.48-2.78). Rates were similar between men and women for both stroke (HR = 2.10; 95% CI, 2.00-2.21 vs. HR = 2.13; 95% CI, 2.04-2.22) and congestive heart failure (HR = 2.63; 95% CI, 2.50-2.77 vs. HR = 2.56; 95% CI, 2.42-2.69), according to researchers.

After stratifying by age decades, women with diabetes had a significantly higher excess risk for acute MI , with the highest difference found in women aged 45 to 54 years (HR = 5.83; 95% CI, 4.23-7.72) when compared with men with diabetes in the same age group (HR = 2.88; 95% CI, 2.50-3.30).

When comparing hospitalizations for stroke and congestive heart failure by age decades, women had a higher excess risk than men from ages 55 to 64 years up to 75 to 84 years, with the highest difference for women aged 55 to 64 years for both stroke and congestive heart failure, according to researchers.

“All of this prompts more careful attention to strategies used to counteract the negative effect of diabetes, especially in women and especially in some ‘risk-time windows,’ such as the perimenopausal age period,” Seghieri said.

Seghieri said clinicians should be more proactive in searching for altered glycemic metabolism in women, while also searching for CVD risk factors in women with diabetes.

“Using administrative databases, as in my case, is not sufficient,” Seghieri said. “More studies, using more complete registries, should be used with the aim of finding what really is behind this gender difference that disadvantages diabetic women when compared with diabetic males.” – by Regina Schaffer

Source: www.healio.com