Clinical Investigation
Coronary Artery Disease
Gender differences in clinical outcomes among diabetic patients hospitalized for cardiovascular disease

https://doi.org/10.1016/j.ahj.2013.02.024Get rights and content

Background

The risk of incident cardiovascular disease (CVD) has been shown to be greater among diabetic women than men, but gender differences in clinical outcomes among diabetic patients hospitalized with CVD are not established. We aimed to determine if hemoglobin A1c (HbA1c) was associated with 30-day and 1-year CVD rehospitalization and total mortality among diabetic patients hospitalized for CVD, overall and by gender.

Methods

This was a prospective analysis of diabetic patients hospitalized for CVD, enrolled in an National Heart, Lung and Blood Institute-sponsored observational clinical outcomes study (N = 902, 39% female, 53% racial/ethnic minority, mean age 67 ± 12 years). Laboratory, rehospitalization, and mortality data were determined by hospital-based electronic medical record. Poor glycemic control was defined as HbA1c ≥7%. The association between HbA1c and clinical outcomes was evaluated using logistic regression; gender modification was evaluated by interaction terms and stratified models.

Results

Hemoglobin A1c ≥7% prevalence was 63% (n = 566) and was similar by gender. Hemoglobin A1c ≥7% vs <7% was associated with increased 30-day CVD rehospitalization in univariate (odds ratio [OR] = 1.63, 95% CI 1.05-2.54) and multivariable-adjusted models (OR 1.74, 95% CI 1.06-2.84). There was an interaction between glycemic control and gender for 30-day CVD rehospitalization risk (P = .005). In stratified univariate models, the association was significant among women (OR 4.83, 95% CI 1.84-12.71) but not among men (OR 1.02, 95% CI 0.60-1.71). The multivariate-adjusted risk for HbA1c ≥7% versus <7% among women was 8.50 (95% CI 2.31-31.27) and 1.02 (95% CI 0.57-1.80) for men. A trend toward increased 30-day/1-year mortality risk was observed for HbA1c <6% vs ≥6% for men and women.

Conclusions

Risk of 30-day CVD rehospitalization was 8.5-fold higher among diabetic women hospitalized for CVD with HbA1c ≥7% vs <7%; no association was observed among men. A trend for increased 30-day/1-year mortality risk with HbA1c <6% deserves further study.

Section snippets

Study design and participants

This study was a prospective analysis of diabetic patients hospitalized for CVD (N = 902) who participated in the National Heart, Lung and Blood Institute–sponsored Family Cardiac Caregiver Investigation To Evaluate Outcomes (FIT-O) study. The design and methods of FIT-O have been previously described.20 Briefly, FIT-O was a prospective cohort study that evaluated patterns of caregiving and the relation to clinical outcomes of consecutively admitted patients to the cardiovascular service at an

Results

The baseline characteristics of the study population and differences among men and women are listed in Table I. Among 902 hospitalized CVD diabetic patients, the mean age was 67 ± 12 years. More than half of participants were racial/ethnic minorities, and approximately one-third were women. More women vs men were older than 65 years (64% vs 55%, P = .01), were racial/ethnic minorities (60% vs 48%, P = .01), and lacked health insurance (26% vs 19%, P = .01) compared with men.

The mean HbA1c was

Discussion

Among diabetic patients hospitalized for CVD, HbA1c ≥7% vs <7% was associated with a significant increased risk of 30-day CVD rehospitalization, which varied significantly by gender. Notably, the increased risk associated with poor glycemic control was 8.5-fold among women in gender-stratified multivariable-adjusted models; no association was observed among men. The gender disparity was not explained by differences in age or other measured confounders. The association between HbA1c ≥7% and

Disclosures

The authors have no conflicts of interest to disclose and no relationships to industry related to this research.

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