Diabetes mellitus: clinical presentation and outcome in men and women with acute coronary syndromes. Data from the Euro Heart Survey ACS

Dotevall, Annika; Hasdai, David; Wallentin, Lars; Battler, Alexander; Rosengren, Annika

doi:10.1111/j.1464-5491.2005.01696.x

Cited by 50 publications

(34 citation statements)

References 35 publications

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“…One other important difference between women with and without diabetes and acute coronary syndrome is the extent of atheromatosis and stenosis of the coronary arteries. Women with diabetes more frequently have significant stenosis in all three coronary arteries, to the same extent as men with diabetes, while women without diabetes more frequently have non-obstructive coronary artery disease [78].…”

Section: Acute Coronary Syndromes In Women and Diabetesmentioning

confidence: 87%

Type 2 diabetes and cardiovascular disease in women

2012

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Cardiovascular disease is the leading cause of death in both men and women. This is also true for patients with diabetes. In general, differences between the sexes are present in several areas, such as epidemiology, pathophysiology, diagnostics, treatment response and prognosis, as well as the way in which disease is experienced and expressed. Cardiovascular disease presents later in life in women, who are therefore more likely to suffer from comorbidities. However, this agerelated difference is attenuated in women with diabetes, who suffer their first myocardial infarction at about the same age as men with diabetes. Diabetes mellitus increases the risk of cardiovascular disease by three to four times in women and two to three times in men, after adjusting for other risk factors. This paper describes the differences in cardiovascular disease in men and women and the special situation of women with type 2 diabetes when it comes to risk factors, symptoms and the setting of acute coronary syndromes. Furthermore, it highlights the importance of sex-specific analyses in clinical research to improve our knowledge of cardiovascular disease in women in general and in women with diabetes in particular. The importance of taking sex into account when treating women and men at risk of cardiovascular disease is discussed. Sex aspects in cardiovascular diseaseDespite a remarkable improvement in life expectancy and a decline in cardiovascular mortality during the last few decades, cardiovascular disease (CVD) is still the leading cause of death in men and women ( Fig. 1) . The major causes of CVD are ischaemic heart disease and stroke. Ageing populations and improved CVD survival will increase morbidity and step up the demands imposed on healthcare systems in the future. CVD has traditionally been perceived as a male illness but, in Europe-with the exceptions of France, the Netherlands and Spain-at least, it ends the lives of as many women as men [2], and worldwide, CVD is the most common cause of death in women in most countries except for Africa, especially above 60 years of age [3]. The ongoing global epidemics of obesity and diabetes will further accelerate this problem [4]. Women's health has traditionally focused on matters related to sexual and reproductive health. The lack of awareness of CVD in women, among both clinicians and women themselves, is especially alarming in countries with low or intermediate incomes, where public-health policy has largely focused on infectious diseases in general and the maternal and reproductive health of women in particular.

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Section: Acute Coronary Syndromes In Women and Diabetesmentioning

confidence: 87%

Type 2 diabetes and cardiovascular disease in women

2012

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Section: Cukrzycaunclassified

“…W przypadku NSTE-ACS chorzy na cukrzycę są starsi, częściej występują u nich rozpoznana choroba CV, nadciśnienie tętnicze i niewydolność nerek oraz cechuje ich wyższe prawdopodobieństwo wystąpienia nietypowych objawów [411,426]. Chorzy na cukrzycę są w trakcie hospitalizacji bardziej podatni na wystąpienie powikłań zwiążanych z ACS, takich jak niewydolność serca, udar mózgu, ponowny zawał serca, niewydolność nerek i krwawienia [106,426]. Na podstawie zbiorczej analizy obejmującej 15 459 pacjentów z NSTE-ACS wykazano, że cukrzyca jest niezależnie związana z podwyższonym ryzykiem 30-dniowej [2,1% vs. 1,1%; OR 1,78 (95% CI 1,24-2,56); p < 0,001] i rocznej śmiertelności [7,2% vs. 3,1%; skorygowany HR 1,65 (95% CI 1,30-2,10); p < 0,001] [427].…”

Section: Cukrzycaunclassified

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

207

165

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“…10 However, according to data from records, diabetic patients with ACS are less frequently subjected to revascularization in any form and are rarely prescribed thienopyridines or GP IIb/ IIIa inhibitors. 10,11 Patients with DM represent a group at a high risk of developing cardiovascular disease. According to European Society of Cardiology guidelines for the management of NSTEMI from 2011, presence of DM against the background of UA/NSTEMI necessitates invasive examination and possible revascularization within the fi rst 72 hours after hospitalization even in the absence of dynamics in the ST segment or positive markers of myocardial necrosis.…”

Section: Discussionmentioning

confidence: 99%

Timing of Invasive Strategy in Diabetic and Non-Diabetic Patients with Non-St-Segment Elevation Acute Coronary Syndrome

Dimitrov

Симова²,

Mateev³

et al. 2013

Folia Medica

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INTRODUCTION: Patients with acute coronary syndrome without ST segment elevation are a heterogeneous group with respect to the risk of having a major adverse cardiac event (MACE). A history of diabetes mellitus (DM) is no doubt one of the factors that defi ne a patient as being at a higher risk of having the syndrome. AIM: To compare early invasive strategy with selective invasive strategy indicated for patients with and without DM. PATIENTS AND METHODS: The study enrolled 178 patients with unstable angina or non-ST elevation myocardial infarction (UA/NSTEMI), and of these 52 (29.2%) had DM. Patients were randomly assigned to an early invasive strategy (these were scheduled to undergo coronary arteriography and percutaneous coronary intervention within 24 hours after admission) or to a selective invasive strategy (at fi rst these were medically stabilized, with coronary arteriography required only in case of angina recurrence and/or evidence of inducible myocardial ischemia). The patients were followed up for a mean period of 22.8 ± 14 months. RESULTS: In the follow up the diabetics allocated to an early invasive strategy were found to have a signifi cantly lower angina recurrence incidence (p = 0.005), rehospitalization rate (p = 0.001), fewer arteriographies (p = 0.001) and coronary interventions (p = 0.001) and low cumulative incidence of MACE (p = 0.008) in comparison with the diabetics assigned to selective invasive strategy. We also found, using the Kaplan-Meier curves survival analysis, that the time to MACE in patients assigned to an early invasive strategy was signifi cantly longer than that in the group of selective invasive strategy. In the follow-up of non-diabetics we found no signifi cant difference in MACE rate between the patients allocated to early invasive strategy and those assigned to selective invasive strategy. In the selective invasive strategy group, however, the cardiovascular adverse events tended to occur earlier than in the early invasive strategy group. CONCLUSIONS: Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndrome is associated with a reduced MACE rate compared with the selective invasive strategy used in these patients. Early invasive strategy applied in diabetic patients is also associated with a signifi cantly longer time to MACE. In non-diabetics the advantages of early over selective invasive strategy are not so clearly differentiated.

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Diabetes mellitus: clinical presentation and outcome in men and women with acute coronary syndromes. Data from the Euro Heart Survey ACS

Cited by 50 publications

References 35 publications

Type 2 diabetes and cardiovascular disease in women

Type 2 diabetes and cardiovascular disease in women

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Timing of Invasive Strategy in Diabetic and Non-Diabetic Patients with Non-St-Segment Elevation Acute Coronary Syndrome

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