Impact of diabetes and gender on survival after acute myocardial infarction in the Province of Quebec, Canada-a population-based study

• Published in: Diabetic medicine Vol. 26; no. 6; pp. 609 - 616
• Main Authors: Ouhoummane, N., Abdous, B., Émond, V., Poirier, P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-06-2009; Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetes Mellitus - mortality; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; gender; Humans; Male; Medical sciences; Middle Aged; myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - mortality; Quebec; Retrospective Studies; Sex Factors; survival; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult; Canada; North America; America; Quebec; Endocrinopathy; Myocardial infarction; Obesity; Nutrition; gender; Acute; Diabetes mellitus; Nutrition disorder; Sex; Cardiovascular disease; Metabolic diseases; Coronary heart disease; Myocardial disease; Statistical study; Survival; Endocrinology; Nutritional status
• DOI: 10.1111/j.1464-5491.2009.02740.x
• EISSN: 1464-5491
• ISSN: 0742-3071

Aims  To examine the impact of diabetes, gender and their interaction on 30‐day, 1‐year and 5‐year post‐acute myocardial infarction (AMI) mortality in three age groups (20–64, 65–74 and ≥ 75 years).
Methods  Retrospective analysis including 23 700 patients aged ≥ 20 years (22% with diabetes) admitted to hospital for a first AMI in any hospital in the Province of Quebec, Canada, between April 1995 and March 1997. Administrative databases were used to identify patients and assess outcomes.
Results  Regarding 30‐day mortality, there was non‐significant interaction between diabetes and gender. Women aged < 75 years had, independently of diabetes status, at least a 38% (P < 0.05) higher mortality than their male counterparts after adjustment for socio‐economic status and co‐morbid conditions. Gender difference disappeared, however, after controlling for in‐hospital complications. Regarding 1‐year mortality (31–365 days), there was no significant gender disparity for all age groups. During the 5‐year follow‐up, no gender differences were seen in any age group, except for younger (< 65 years) women with diabetes, who had a 52% (P = 0.004) higher mortality than men after controlling for co‐variables. This female disadvantage was demonstrated by a significant interaction between diabetes and gender in patients aged < 65 years (P = 0.009).
Conclusions  The higher 30‐day mortality post‐AMI in younger (20–64 years) and middle‐aged (65–74 years) women compared with men was not influenced by diabetes status. However, during the 5‐year follow‐up, the similar gender mortality observed in patients without diabetes seemed to disappear in younger patients with diabetes, which may be explained by the deleterious, long‐term, post‐AMI impact of diabetes in younger women.