Abstract
Diabetes mellitus (DM) predicts ominous outcomes in acute pulmonary embolism (PE). The influence of gender on the prognostic impact of DM in PE is unknown. We did a retrospective analysis of a cohort of patients hospitalized with PE between 2006 and 2013. The exclusion criteria were age <18, non-pulmonary veins thromboembolism, recurrent PE, chronic thromboembolic pulmonary hypertension, no radiologic confirmation of PE, and active neoplasia. The primary endpoint was all-cause mortality. The follow-up was from diagnosis until October 2017. We assessed the prognostic impact of DM using a multivariate Cox regression analysis. The analysis was stratified according to gender. The interaction between gender and DM in the outcome of patients with PE was tested. We studied 577 PE patients (median age 65 years, 36.9% men, 19.8% diabetic). The genders were similar regarding the prevalence of DM, the extension and location of PE, and the thrombolytic therapy or brain natriuretic peptide (BNP) value. Diabetics presented higher all-cause mortality (Hazard ratio (HR) = 2.33 (95% confidence Interval (CI) 1.513.61)) when compared with non-diabetics. However, when analysis was stratified according to gender, DM was independently associated with a worse prognosis only in women (HR = 2.31 (95% CI 1.453.65)), while in men the HR was 1.10 (95% CI 0.592.04). The interaction between gender and DM was significant (p = 0.04). Gender influences the prognostic impact of DM in acute PE. Diabetic women with PE have twice the long-term mortality risk, while DM is not mortality-associated in men.
Highlights
Diabetes mellitus (DM) is a very prevalent chronic disease that affects over 20 million people worldwide
We studied 577 patients hospitalized with acute pulmonary embolism (PE) with no concomitant active neoplasia
No differences existed between men and women concerning the prevalence of DM, PE extension, or need of reperfusion therapy
Summary
Diabetes mellitus (DM) is a very prevalent chronic disease that affects over 20 million people worldwide. Premenopausal females appear to be protected against the disease in part due to the presence of estrogens, when present, the burden of DM is greater among women [3,4] Both physiological particularities and gender differences concerning the care provided are possible explanations for this differential impact of DM according to gender in the outcome of many diseases [4,5]. The coexistence of DM conferred a higher risk of all-cause and cardiovascular mortality upon women with heart failure with preserved ejection fraction (HFpEF), but not upon men [9,10] This women-selective survival disadvantage of diabetes seems to occur in CHD [1,5]
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