Gender difference in the association between prediabetes and post-myocardial infarction prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Higher incident coronary heart disease in females with prediabetes compared to males is seen in the general population. This interaction in post-MI patients for recurrent events is largely unexplored. Purpose Explore the interaction between sex and newly diagnosed glycaemic abnormalities in terms of its association with recurrent cardiovascular events. Methods Retrospective analysis of a cohort of MI-survivors without known diabetes who had pre-discharge OGTT. MACE (death and non-fatal MI) had fasting (FPG) and 2-hour post-load plasma glucose (2h-PG), were recorded. Cox regression models adjusted for confounders were used. The modifying effect of sex on the association between MACE and, glycaemic groups or fasting or post-load glucose levels was tested by adding an interaction term combining gender and glycaemic category prediabetes (pDM) and new diabetes (NDM) (pDM*sex and NDM*sex) or glucose levels (FPG*sex and 2h-PG*sex) to the base model to additionally adjust for sex-specific confounding. Results Crude MACE was higher in women with pDM (35.8% v 16.7%, p=0.001) and men with NDM (29.6% v 17.3%, p=0.003) compared to normal glucose tolerance (NGT). Adjusted MACE was higher only in women with pDM (HR 2.15, 95% CI 1.24 to 3.72, p=0.007) and only in men with NDM (HR 1.57, 95% CI 1.01 to 2.42, p=0.044) compared to NGT. In pDM group, risk of MACE was higher in women compared to men (HR 1.72, 95% CI 1.13 to 2.60, p=0.011), (p for interaction=0.040) but not NDM (HR 0.83, 95% CI 0.43 to 1.60, p=0.575), (p for interaction=0.378). Increasing 2h-PG, but not FPG, was associated with MACE in both sexes with no sex interaction. Compared to NGT, IGT, not IFG, predicted MACE in women, (HR 2.08, 95% CI 1.21 to 3.57, p=0.008) but not in men, (p for interaction=0.043). 2h-PG determined NDM predicted MACE in men (HR 1.59, 95% CI 1.04 to 2.44, p=0.034) but not in women without sex interaction, (p for interaction=0.365) (Fig 2). Conclusion Female sex adversely modifies the association between 2h-PG determined pDM and post-MI MACE. Risk of MACE. Relation between categories and MACE.