Diabetes mellitus in acute coronary syndromes – worse for women

Diabetes is associated with worse prognosis in patients with myocardial infarction, but if there is a difference between men and women in this respect is less well known.

In an analysis of 10253 patients (3329 women) with a discharge diagnosis of acute coronary syndrome (myocardial infarction or unstable angina) in the Euro Heart Survey ACS. Of the women, 28% had DM and of the men 20%.

Compared to men without diabetes, men with diabetes tended to have less severe disease, that is less ST-elevation AMI (the form of myocardial infarction associated with the highest early mortality) and more unstable angina, a more benign form of acute coronary disease. This difference was largely due to the fact that men with diabetes more often had been hospitalised before with myocardial infarction and had more medications.

In women, the situation was different. Compared to women without diabetes, women with diabetes had more ST-elevation AMI and less unstable angina, after considering that diabetic women had more previous myocardial infarction and more medication.

Of the women with diabetes, 8.6% died in hospital, compared to 4.9% among women without diabetes with corresponding mortality rates among men with and without diabetes of 4.8% and 4.0%, respectively.

Conclusion: Diabetes in women with ACS is associated with higher risk of presenting with ST-elevation-ACS and of in-hospital mortality, whereas diabetes in men with ACS is not associated with increased risk of either. These findings suggest a differential effect of DM on the pathophysiology of ACS based on the patient's sex.

This article "Diabetes and the heart" accompanies both a presentation and an ESC press conference given at the ESC Congress 2004.