Diabetes mellitus: clinical presentation and outcome in men and women with acute coronary syndromes. Data from the Euro Heart Survey ACS

Abstract

Abstract Aims To study clinical presentation, in‐hospital course and short‐term prognosis in men and women with diabetes mellitus and acute coronary syndromes (ACS). Methods Men ( n = 6488, 21.2% with diabetes) and 2809 women (28.7% with diabetes) ≤ 80 years old, with a discharge diagnosis of ACS were prospectively enrolled in the Euro Heart Survey of ACS. Results Women with diabetes were more likely to present with ST elevation than non‐diabetic women, a difference that became more marked after adjustment for differences in smoking, hypertension, obesity, medication and prior disease [adjusted odds ratio (OR) 1.46 (1.20, 1.78)], whereas there was little difference between diabetic and non‐diabetic men [adjusted OR 0.99 (0.86, 1.14)]. In addition, women with diabetes were more likely to develop Q‐wave myocardial infarction (MI) than non‐diabetic women [adjusted OR 1.61 (1.30, 1.99)], while there was no difference between men with and without diabetes [adjusted OR 0.99 (0.85, 1.15)]. There were significant interactions between sex, diabetes and presenting with ST‐elevation ACS ( P < 0.001), and Q‐wave MI ( P < 0.001), respectively. Of the women with diabetes, 7.4% died in hospital, compared with 3.6% of non‐diabetic women [adjusted OR 2.13 (1.39, 3.26)], whereas corresponding mortality rates in men with and without diabetes were 4.1% and 3.3%, respectively [OR 1.13 (0.76, 1.67)] ( P for diabetes–sex interaction 0.021). Conclusion In women with ACS, diabetes is associated with higher risk of presenting with ST‐elevation ACS, developing Q‐wave MI, and of in‐hospital mortality, whereas in men with ACS diabetes is not significantly associated with increased risk of either. These findings suggest a differential effect of diabetes on the pathophysiology of ACS based on the patient's sex.