Diabetic Women More Likely To Die After Heart Attack

"The female advantage with fewer cardiovascular events than in men at younger ages is attenuated once a woman has the diagnosis of diabetes," Dr. Anna Norhammar and associates report.

They sought to identify gender-related differences in prognosis, risk factors, or treatment among 25,555 patients younger than age of 65 treated for heart attack between 1995 and 2002. In this cohort, 23 percent were women and 21 percent of women and 16 percent of men were previously diagnosed with diabetes.

During an average follow-up of 4.4 years, diabetic women had a 34 percent increased risk of dying, compared with diabetic men.

Compared with the male patients, female patients had higher rates of high blood pressure and heart failure and were more likely to smoke.

Fewer women than men had had procedures to open clogged arteries prior to their first heart attack, and women were less likely to be treated with blood pressure drugs called beta-blockers or ACE inhibitors.

Nevertheless, Norhammar, at Karolinska University Hospital in Stockholm, and her team attribute the higher death rate in diabetic women younger than 65, relative to diabetic men of the same age, to risk factors rather than treatment differences.
"The present observation makes further study of the impact of improved risk factor management in this particular group of relatively young, easily identifiable, high-risk patients important," the researchers conclude, "together with attempts to initiate treatment and cardiac investigations before their first (heart attack) or the onset of heart failure."

Heart, November 2008.