Impact of MI & Diabetes on Overall Health Differs Between the Sexes

In men myocardial infarction increases the risk of death from heart disease more so than diabetes, but in women diabetes is a greater mortality threat. Dr. Gang Hu from National Public Health Institute and University of Helsinki, stated that "In general, diabetes is bad news for women." "More aggressive management of diabetes to prevent cardiovascular disease may be needed, particularly in women."
In the study, the investigators compared the effects of diabetes and MI on the risk of death in two cohorts of patients: a baseline cohort, which included 2416 patients with prior diabetes or MI who were followed for 12 years; and a follow-up cohort, which included 4315 patients who were diagnosed with incident diabetes or MI during follow-up and were further followed for 7.7 years after diagnosis.

Most previous studies only had a "single baseline measurement for the disease status of diabetes and MI," Dr. Hu pointed out.
In the baseline cohort, men with prior MI had a 20% to 80% increased risk of death from CHD or any cause, whereas women with prior MI had a 43% to 45% decreased risk of CHD or total mortality compared with men and women with prior diabetes.
In the follow-up cohort, men and women with incident MI had a greater risk of dying from heart disease, with hazard ratios of 2.15 and 1.65, respectively, compared with men and women with incident diabetes.

Total mortality, however, was similar between subjects with incident diabetes and MI during follow up, Dr. Hu said. For people with incident MI, CHD is "the major cause of death," Dr. Hu explained, whereas people with incident diabetes may be at increased risk of dying from CHD, stroke, cancer, kidney disease, infection and other causes. Thus, total mortality is similar between subjects with incident diabetes and MI, which highlights the importance of diabetes on overall health, the researcher added.

In a statement, Dr. Christiane E. Angermann, from the University of Wurzburg in Germany said this study provides "yet another strong argument for the necessity to consider gender-related differences between men and women regarding the impact of risk factors, while designing guidelines not only for diagnosis and therapy, but also, and in particular, for the prevention of cardiovascular disease."
J Am Coll Cardiol 2005;45:1413-1418.

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FACT:
Inflammation and diabetes: Recent data have shown that inflammation is important in the pathogenesis of atherosclerosis, thrombosis, and microalbuminuria in people with and without diabetes. In a report from the EURODIAB prospective complications study, which included 3,250 men and women with type 1 diabetes (15). The data showed that markers of inflammation are strongly and independently associated with microvascular complications and cardiovascular disease. The authors suggested that inflammation itself is involved in the pathophysiological pathway leading to vascular complications. Strategies that decrease inflammatory activity may help to prevent the development of vascular complications in type 1 diabetes. Diabetologia,48 (370-378): Schram M, Chaturvedi N, Schalkwijk C, Fuller J, Stehouwer C; EURODIAB Prospective Complications Study Group Markers of inflammation are cross-sectionally associated with microvascular complications and cardiovascular disease in type 1 diabetes–the EURODIAB Prospective Complications Study