Sex Differences in the Prognostic Importance of Diabetes in Patients With Ischemic Heart Disease Undergoing Coronary Angiography

Sex Differences in the Prognostic Importance of Diabetes in Patients With Ischemic Heart Disease Undergoing Coronary Angiography Michelle M. Graham , MD 1 , William A. Ghali , MD, MPH 2 , Peter D. Faris , PHD 3 , P. Diane Galbraith , BN 4 , Colleen M. Norris , PHD 5 , Merril L. Knudtson , MD 6 and APPROACH Investigators 1 Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada 2 Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada 3 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada 4 APPROACH Project Office, Calgary, Alberta, Canada 5 Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada 6 Department of Medicine, University of Calgary, Calgary, Alberta, Canada Address correspondence and reprint requests to Dr. Michelle M. Graham, Division of Cardiology, University of Alberta Hospital, 8440-112 St., Edmonton, Alberta, Canada, T6G 2R7 E-mail: mmgraham{at}cha.ab.ca Abstract OBJECTIVE —Women with ischemic heart disease have poorer outcomes than men and are suggested to have greater risk associated with diabetes. We evaluated the prognosis associated with diabetes, in analyses stratified by sex, to determine whether similar differences are seen in a large unselected cohort of patients. RESEARCH DESIGN AND METHODS —Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), a clinical data collection and follow-up initiative capturing all patients undergoing cardiac catheterization in Alberta, Canada, the relative significance of diabetes on long-term survival in 13,152 men and 4,249 women was evaluated in patients presenting with or without myocardial infarction and according to first treatment received. RESULTS —The 1-year mortality rates were 4.7% and 6.8% in men and women ( P < 0.001), 4.1% and 7.4% in nondiabetic and diabetic men ( P < 0.001), and 5.8% and 9.6% in nondiabetic and diabetic women, respectively ( P < 0.001). The risk-adjusted Cox proportional hazard ratios associated with diabetes in myocardial infarction were 1.03 in men and 1.20 in women. The diabetes hazard ratios for percutaneous coronary intervention were 1.28 in men and 1.40 in women, 1.23 in men and 1.32 in women for bypass surgery, and 1.26 in men and 1.31 in women for medical therapy ( P = NS for all diabetes hazard ratio comparisons between men and women). CONCLUSIONS —Hazard ratios quantifying the adverse prognosis as