Gender differences in outcome in patients with diabetes mellitus.


Journal

Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
ISSN: 1532-6551
Titre abrégé: J Nucl Cardiol
Pays: United States
ID NLM: 9423534

Informations de publication

Date de publication:
Feb 2022
Historique:
received: 23 01 2020
accepted: 07 05 2020
pubmed: 28 5 2020
medline: 30 4 2022
entrez: 28 5 2020
Statut: ppublish

Résumé

Diabetes mellitus is an independent risk factor in the development of coronary artery disease (CAD), myocardial infarction (MI), and cardiac death (CD). The major adverse cardiac events (MACEs) between men and women in diabetic patients stratified by CAD (previous MI and/or coronary revascularization, CR) were analyzed. A cohort of 1327 consecutive diabetic patients (age 66.5 ± 9 years) underwent gated SPECT (single-photon emission computed tomography). During a mean follow-up of 4.7 ± 2.2 years post gated SPECT, MACEs (non-fatal MI, CD, and late CR) were evaluated according to gender stratified by CAD. Among diabetic patients without known CAD (N = 731), men had more MACEs (sHR 1.9;95%CI 1.2-3.2) than women. Among diabetic patients with known CAD (N = 596), there was no difference in MACEs in diabetic men and women (sHR 1.15;95%CI 0.73-1.8). Diabetic women with known CAD (n = 143) were the group with the highest risk (sHR 1.7; P = .041) for MACEs (4.5% MACEs/year, [95%CI 3.1%-6.4%]), compared to the remaining diabetic patients (N = 1184) (3% MACEs/year, [95%CI 2.6%-3.5%]). The prognosis of diabetic patients for MACEs is different in men and women stratified by CAD. The worst prognosis for MACEs occurs in women with known CAD.

Sections du résumé

BACKGROUND BACKGROUND
Diabetes mellitus is an independent risk factor in the development of coronary artery disease (CAD), myocardial infarction (MI), and cardiac death (CD). The major adverse cardiac events (MACEs) between men and women in diabetic patients stratified by CAD (previous MI and/or coronary revascularization, CR) were analyzed.
METHODS AND RESULTS RESULTS
A cohort of 1327 consecutive diabetic patients (age 66.5 ± 9 years) underwent gated SPECT (single-photon emission computed tomography). During a mean follow-up of 4.7 ± 2.2 years post gated SPECT, MACEs (non-fatal MI, CD, and late CR) were evaluated according to gender stratified by CAD. Among diabetic patients without known CAD (N = 731), men had more MACEs (sHR 1.9;95%CI 1.2-3.2) than women. Among diabetic patients with known CAD (N = 596), there was no difference in MACEs in diabetic men and women (sHR 1.15;95%CI 0.73-1.8). Diabetic women with known CAD (n = 143) were the group with the highest risk (sHR 1.7; P = .041) for MACEs (4.5% MACEs/year, [95%CI 3.1%-6.4%]), compared to the remaining diabetic patients (N = 1184) (3% MACEs/year, [95%CI 2.6%-3.5%]).
CONCLUSIONS CONCLUSIONS
The prognosis of diabetic patients for MACEs is different in men and women stratified by CAD. The worst prognosis for MACEs occurs in women with known CAD.

Identifiants

pubmed: 32458331
doi: 10.1007/s12350-020-02195-0
pii: 10.1007/s12350-020-02195-0
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

72-82

Informations de copyright

© 2020. American Society of Nuclear Cardiology.

Références

Miller RG, Costacou T, Orchard TJ. Risk factor modeling for cardiovascular disease in Type 1 diabetes in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study: A comparison with the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC). Diabetes 2019;68:409-19.
doi: 10.2337/db18-0515
Ferencik M. Paradigms of noninvasive assessment of coronary atherosclerosis in diabetic patients: Insights from the PARADIGM Registry. JACC Cardiovasc Imaging 2018;11:1472-4.
doi: 10.1016/j.jcmg.2018.04.024
Barmpouletos D, Stavens G, Ahlberg AW, Katten DM, O’Sullivan DM, Heller GV. Duration and type of therapy for diabetes: Impact on cardiac risk stratification with stress electrocardiographic-gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2010;17:1041-9.
doi: 10.1007/s12350-010-9293-4
Santos MT, Parker MW, Heller GV. Evaluating gender differences in prognosis following SPECT myocardial perfusion imaging among patients with diabetes and known or suspected coronary disease in the modern era. J Nucl Cardiol 2013;20:1021-9.
doi: 10.1007/s12350-013-9771-6
Morales DCV, Bhavnani SP, Ahlberg AW, Pullatt RC, Katten DM, Polk DM, et al. Coronary risk equivalence of diabetes assessed by SPECT-MPI. J Nucl Cardiol 2019;26:1093-102.
doi: 10.1007/s12350-017-1114-6
Ghatak A, Padala S, Katten DM, Polk DM, Heller GV. Risk stratification among diabetic patients undergoing stress myocardial perfusion imaging. J Nucl Cardiol 2013;20:529-38.
doi: 10.1007/s12350-013-9731-1
Blanke P, Naoum C, Ahmadi A, Cheruvu C, Soon J, Arepalli C, et al. Long-term prognostic utility of coronary CT angiography in stable patients with diabetes mellitus. JACC Cardiovasc Imaging 2016;9:1280-8.
doi: 10.1016/j.jcmg.2015.12.027
Wackers FJTh, Young LH. Lessons learned from the detection of ischemia in asymptomatic diabetics (DIAD) study. J Nucl Cardiol 2009;16:855-9.
doi: 10.1007/s12350-009-9138-1
Shaw LJ, Cerqueira MD, Brooks MM, Althouse AD, Sansing VV, Beller GA, et al. Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. J Nucl Cardiol 2012;19:658-69.
doi: 10.1007/s12350-012-9548-3
Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, et al. Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2003;24:28-66.
pubmed: 12559937
Salomaa V, Koukkunen H, Ketonen M, Immonen-Räihä P, Kärjä-Koskenkari P, Mustonen J, et al. A new definition for myocardial infarction: What difference does it make? Eur Heart J 2005;26:1719-25.
doi: 10.1093/eurheartj/ehi185
Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138-47.
pubmed: 7472611
Gooley TA, Leisenring W, Crowley J, Storer BE. Estimation of failure probabilities in the presence of competing risks: New representations of old estimators. Stat Med 1999;18:695-706.
doi: 10.1002/(SICI)1097-0258(19990330)18:6<695::AID-SIM60>3.0.CO;2-O
Kalbfleisch JD, Prentice RL. Competing risks and multistate models. In: The statistical analysis of failure time data. Secondth edition. Edited by Wiley series in probability and statistics. New Jersey: Balding DJ; 2002. p. 247-77.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risks. J Am Stat Assoc 1999;94:496-509.
doi: 10.1080/01621459.1999.10474144
Leuven E, Sianesi B. PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. Statistical Software Components S432001, Boston College Department of Economics, revised 01 Feb 2018; 2003
Elze MC, Gregson J, Baber U, Williamson E, Sartori S, Mehran R, et al. Comparison of propensity score methods and covariate adjustment: Evaluation in 4 cardiovascular studies. J Am Coll Cardiol 2017;69:345-57.
doi: 10.1016/j.jacc.2016.10.060
Heinze G, Juni P. An overview of the objectives of and the approaches to propensity score analyses. Eur Heart J 2011;32:1704-8.
doi: 10.1093/eurheartj/ehr031
Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE. Regression methods in biostatistics: Linear, logistic, survival, and repeated measures models. 2nd ed. New York: Springer; 2012.
doi: 10.1007/978-1-4614-1353-0
Wooldridge JM. Inverse probability weighted estimation for general missing data problems. J Econom 2007;141:1281-301.
doi: 10.1016/j.jeconom.2007.02.002
Stata treatment-effects reference manual: potential outcomes/counterfactual outcomes. Release 15. Texas: Published by Stata Press; 2017. p. 70-75.
Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 2015;34:3661-79.
doi: 10.1002/sim.6607
Kim U, Leipsic JA, Sellers SL, Shao M, Blanke P, Hadamitzky M, et al. Natural history of diabetic coronary atherosclerosis by quantitative measurement of serial coronary computed tomographic angiography: Results of the PARADIGM study. JACC Cardiovasc Imaging 2018;11:1461-71.
doi: 10.1016/j.jcmg.2018.04.009
Acampa W, Assante R, Zampella E, Petretta M, Cuocolo A. Myocardial perfusión imaging for diabetes: Key points from the evidence and clinical questions to be answered. J Nucl Cardiol 2019. https://doi.org/10.1007/s12350-019-01846-1 .
doi: 10.1007/s12350-019-01846-1 pubmed: 31875285
Goraya TY, Leibson CL, Palumbo PJ, Weston SA, Killian JM, Pfeifer EA, et al. Coronary atherosclerosis in diabetes mellitus: A population-based autopsy study. J Am Coll Cardiol 2002;40:946-53.
doi: 10.1016/S0735-1097(02)02065-X
Taskinen MR, Boren J. New insights into the pathophysiology of dyslipidemia in type 2 diabetes. Atherosclerosis 2015;239:483-95.
doi: 10.1016/j.atherosclerosis.2015.01.039
Cifkova R, Pitha J, Krajcoviechova A, Kralikova E. Is the impact of conventional risk factors the same in men and women? Plea for a more gen der-specific approach. Int J Cardiol 2019;286:214-9.
doi: 10.1016/j.ijcard.2019.01.039
Wackers FJ, Chyun DA, Young LH, et al. Resolution of asymptomatic myocardial ischemia in patients with type 2 diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study. Diabetes Care 2007;30:2892-8.
doi: 10.2337/dc07-1250
Venuraju SM, Lahiri A, Jeevarethinam A, Cohen M, Darko D, Nair D, et al. Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study. Cardiovasc Diabetol 2019;18:51.
doi: 10.1186/s12933-019-0855-8
Beller GA, Bourque JM. Screening asymptomatic patients with type 2 diabetes: The debates persist. J Nucl Cardiol 2015;22:1233-6.
doi: 10.1007/s12350-015-0283-4
Haffner SM, Lehto S, Ronemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-34.
doi: 10.1056/NEJM199807233390404
Lautsch D, Wang T, Yang L, Rajpathak SN. Prevalence of established cardiovascular disease in patients with Type 2 diabetes mellitus in the UK. Diabetes Ther 2019;10:2131-7.
doi: 10.1007/s13300-019-00698-9
Birkeland KI, Bodegard J, Norhammar A, Kuiper JG, Georgiado E, Beekman-Hendriks WL, et al. How representative of a general type 2 diabetes population are patients included in cardiovascular outcome trials with SGLT2 inhibitors? A large European observational study. Diabetes Obes Metab 2019;21:968-74.
doi: 10.1111/dom.13612
Naidoo VV. Review of gated SPECT imaging in women with suspected coronary heart disease. J Nucl Cardiol 2006;13:474-9.
doi: 10.1016/j.nuclcard.2006.06.133
Barrett-Connor EL, Cohn BA, Wingard DL, Edelstein SL. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study. JAMA 1991;265:627-31.
doi: 10.1001/jama.1991.03460050081025
Madonna R, Balistreri CR, De Rosa S, Muscoli S, Selvaggio S, Selvaggio G, et al. Impact of sex differences and diabetes on coronary atherosclerosis and ischemic heart disease. J Clin Med 2019. https://doi.org/10.3390/jcm8010098 .
doi: 10.3390/jcm8010098 pubmed: 30654523 pmcid: 6351940
Laverty AA, Bottle A, Kim SH, Visani B, Majeed A, Millett C. Gender differences in hospital admissions for major cardiovascular events and procedures in people with and without diabetes in England: A nationwide study 2004-2014. Cardiovasc Diabetol 2017;16:100.
doi: 10.1186/s12933-017-0580-0
Acampa W, Cantoni V, Green R, Maio F, Daniele S, Nappi C, et al. Prognostic value of normal stress myocardial perfusion imaging in diabetic patients: a meta-analysis. J Nucl Cardiol 2014;21:893-902.
doi: 10.1007/s12350-014-9918-0

Auteurs

Guillermo Romero-Farina (G)

Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d'Hebron, 119-129, Barcelona, Spain. guiromfar@gmail.com.
Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain. guiromfar@gmail.com.

Santiago Aguadé-Bruix (S)

Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.

Hug Cuellar-Calabria (H)

Radiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.

María Nazarena Pizzi (MN)

Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d'Hebron, 119-129, Barcelona, Spain.
Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.

Albert Roque (A)

Radiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.

Jaume Candell-Riera (J)

Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d'Hebron, 119-129, Barcelona, Spain.
Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.

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