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- July 20, 2008 |
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"DM and Cardiovascular Disease in Women"Dr. Gillian Booth (biography)
English - 2003-05-23 - 28 minutes
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Summary :
We are now all familiar with the increased risk of heart disease in patients with diabetes mellitus (Haffner et al.1998. NEJM 339: 229-34). What about gender differences within this population? The Nurses Health Study showed a marked increase in the risk for diabetic women with a history of CHD to have a fatal CHD event if they had diabetes for over 15 years (Hu et al. 2001. Arch Int Med 161: 1717-23). Our goal was to look at CVD in men and women with diabetes in the general population of Ontario, and see what factors determined a worse outcome. We used administrative data to create the Ontario Diabetes Database (ODD), using hospitalization records and physician service claims, to make a data set containing 600,000 cases. Data on admissions for MI show a decrease in the gender gap between men and women that is seen in the non-diabetic population, where men are about twice as susceptible to MI as women. The relative risk of MI compared to non-diabetics was found to be higher in women, and the difference in relative risk for both genders was found to be higher in the lower age groups. The absolute risk of MI did however increase with age. Socioeconomic status was found to be inversely related to rates of MI, particularly in women. Rural populations were found to be more at risk for MI, and more visits to the doctor was found to be a protective factor against MI. Men and women with diabetes were found to have a 1.4-fold higher risk of mortality 1 year after MI compared to non-diabetics, whereas there was no difference found in mortality rates 1 year after congestive heart failure. Men were found to have consistently higher rates of amputation than women. These results also shed light on the relative risk of stroke, life expectancy, usage of revascularization procedures, and other factors.
Learning objectives :
The participant will review a substantial body of data derived from the Ontario Diabetes Database (ODD) elucidating the following points:
- DM reduces the gender gap in CVD
- Relatively higher CVD procedure use in men than in women
- Both genders – earlier and greater risk of CVD
Bibliographic references :
Arch Intern Med 2001 Jul 23;161(14):1717-23
The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up.
Hu FB, Stampfer MJ, Solomon CG, Liu S, Willett WC, Speizer FE, Nathan DM, Manson JE.
http://archinte.ama-assn.org/cgi/content/abstract/161/14/1717
N Engl J Med 1998 Jul 23;339(4):229-34
Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.
Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M.
http://content.nejm.org/cgi/content/abstract/339/4/229
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