Abstract
BackgroundThe role of sex, and its joint effect with age and diabetes mellitus, on mortality subsequent to surviving an acute myocardial infarction (AMI) beyond 30 days are unclear. The high prevalence of diabetes mellitus in an ethnically diverse Asian population motivates this study.MethodsThe study population comprised of a nationwide cohort of Asian patients with AMI, hospitalized between 2000 to 2005, who survived the first 30 days post-admission and were followed prospectively until death or 12 years.ResultsAmong the 13,389 survivors, there were fewer women (25.5%) who were older than men (median 70 vs. 58 years) and a larger proportion had diabetes mellitus at admission (51.4% vs. 31.4%). During follow-up 4,707 deaths (women 13.2%; men 22.0%) occurred, with women experiencing higher mortality than men with an averaged hazard ratio (HR): 2.08; 95% confidence interval : 1.96-2.20. However the actual adverse outcome, although always greater, reduced over time with an estimated HR: 2.23 (2.04-2.45) at 30 days to HR: 1.75; (1.47-2.09) 12 years later. The difference in mortality also declined with increasing age: HR 1.80 (1.52-2.13) for those aged 22-59, 1.26 (1.11-1.42) for 60-69, 1.06 (0.96-1.17) and 0.96 (0.85-1.09) for those 70-79 and 80-101 years. Significant two-factor interactions were observed between sex, age and diabetes (P < 0.001). Diabetic women <60 years of age had greater mortality than diabetic men of the same age (adjusted HR: 1.44; 1.14-1.84; P = 0.003), while diabetic women and men ≥60 years of age had a less pronounced mortality difference (adjusted HR: 1.12; 0.99-1.26).ConclusionsOne in two women hospitalized for AMI in this Asian cohort had diabetes and the sex disparity in post-MI mortality was most pronounced among these who were <60 years of age. This underscores the need for better secondary prevention in this high-risk group.
Highlights
The role of sex, and its joint effect with age and diabetes mellitus, on mortality subsequent to surviving an acute myocardial infarction (AMI) beyond 30 days are unclear
Over the 12-year follow-up period with a median follow-up of 7.5 years, 1,761 deaths occurred among women (58.0% from cardiovascular death (CVD)) and 2,946 deaths occurred among men (56.2% from Cardiovascular death (CVD))
The corresponding survival curves showed a two-fold increased risk of death in women compared to men (HR: 2.08; 95% confidence interval (CI): 1.96-2.20, P < 0.0001) (Figure 1 (a))
Summary
The role of sex, and its joint effect with age and diabetes mellitus, on mortality subsequent to surviving an acute myocardial infarction (AMI) beyond 30 days are unclear. The high prevalence of diabetes mellitus in an ethnically diverse Asian population motivates this study. Acute myocardial infarction (AMI) is a leading global cause of death in both men and women. Age and diabetes are known determinants of survival following AMI. Data over the past decade have shown that women have a higher 30-day mortality after AMI than men [1,2]. Prior studies suggest that higher early post-MI mortality rates may be limited to younger women, who. We sought to examine the impact of sex and its interaction with age and diabetes on long-term mortality following AMI in a large Asian cohort
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