Sex differences in survival after acute myocardial infarction in patients with diabetes mellitus (Worcester Heart Attack Study)

Crowley, Amber; Menon, Vandana; Lessard, Darleen; Yarzebski, Jorge; Jackson, Elizabeth; Gore, Joel M; Goldberg, Robert J

doi:10.1016/S0002-8703(03)00406-X

« Previous Next »American Heart Journal
Volume 146, Issue 5 , Pages 824-831, November 2003

Sex differences in survival after acute myocardial infarction in patients with diabetes mellitus (Worcester Heart Attack Study)☆

Amber Crowley, MD
- Section of Emergency Medicine, Yale University School of Medicine New Haven, Conn, USA
Vandana Menon, MD, MPH
- Department of Medicine, Division of Clinical Care Research, Tufts University School of Medicine, Boston, Mass, USA
Darleen Lessard, MS
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass, USA
Jorge Yarzebski, MD, MPH
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass, USA
Elizabeth Jackson, MD, MPH
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass, USA
Joel M Gore, MD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass, USA
Robert J Goldberg, PhD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass, USA
- Reprint requests: Robert J. Goldberg, PhD, Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655, USA.

Received 18 October 2002; accepted 11 April 2003.

Abstract

Background

Women with diabetes mellitus are at particularly high risk for coronary heart disease-related morbidity and mortality compared with men with diabetes mellitus. However, recent data comparing hospital and long-term outcomes in women with diabetes mellitus and men hospitalized with acute myocardial infarction (AMI) are scarce. The objectives of our multi-hospital observational study were to examine sex differences and temporal trends (1975–99) in hospital and long-term case-fatality rates (CFRs) in patients with diabetes mellitus and AMI from a population-based perspective.

Methods

A community-wide study of residents of the Worcester, Mass, metropolitan area who were hospitalized with confirmed AMI was conducted. Data were collected in 12 1-year periods between 1975 and 1999. The study sample consisted of 1354 men and 1280 women with diabetes mellitus.

Results

Overall hospital CFRs were significantly greater for women with diabetes mellitus (21.3%) than for men with diabetes mellitus (14.9%). Between 1975 and 1999, hospital CFRs declined from 39.2% to 17.5% for women and from 18.9% to 9.5% in men. In examining long-term survival patterns for as long as 10 years after hospital discharge, there were no significant sex differences in long-term survival rates after adjustment for a limited number of known potentially confounding factors.

Conclusions

Hospital death rates after AMI in men and women with diabetes mellitus have declined in the last 2 decades. The gap in hospital CFRs between men and women with diabetes mellitus has decreased considerably with time, although women have a higher risk of dying after AMI than men. Patients with diabetes mellitus continue to represent a high-risk group who will benefit from enhanced surveillance efforts and increased use of effective cardiac treatments.