Sex Differences in the Prognostic Importance of Diabetes in Patients With Ischemic Heart Disease Undergoing Coronary Angiography
- Michelle M. Graham, MD1,
- William A. Ghali, MD, MPH2,
- Peter D. Faris, PHD3,
- P. Diane Galbraith, BN4,
- Colleen M. Norris, PHD5,
- Merril L. Knudtson, MD6 and
- APPROACH Investigators
- 1Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
- 2Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- 3Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- 4APPROACH Project Office, Calgary, Alberta, Canada
- 5Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- 6Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Address correspondence and reprint requests to Dr. Michelle M. Graham, Division of Cardiology, University of Alberta Hospital, 8440-112 St., Edmonton, Alberta, Canada, T6G 2R7 E-mail: mmgraham{at}cha.ab.ca
Abstract
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% in nondiabetic 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.
Footnotes
-
APPROACH is supported by various industry sponsors (see acknowledgments). Analyses were supported by an operating grant from the Heart and Stroke Foundation of Alberta and the Northwest Territories. W.A.G is supported by a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research, Edmonton, Alberta, and by a Government of Canada Research Chair. He is also an investigator with the Alliance of Canadian Health Outcome Researchers in Diabetes.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
-
- Accepted September 15, 2003.
- Received April 23, 2003.
- DIABETES CARE
