SWEETHEART: Number of new diabetes cases higher in women

Issue: December 2011

AHA Scientific Sessions 2011

ORLANDO, Fla. — Women with STEMI and non-STEMI had higher rates of newly diagnosed diabetes compared with men, according to data from the SWEETHEART registry.

“The objective of the study was to determine the prevalence of abnormal glucose metabolism in MI patients in clinical practice, to see if this does have an impact on hospital long-term outcomes after MI and, of course, to evaluate the adherence to guidelines for management of different subgroups of patients with abnormal glucose metabolism,” Anselm K. Gitt, MD, of Institut für Herzinfarktforschung at the Universität Heidelberg, Germany, said during a presentation of the registry’s results.

To identify abnormal glucose metabolism and document acute treatment and outcome, Gitt and colleagues enrolled 2,767 patients with STEMI or non-STEMI into the registry. An oral glucose tolerance test was performed 4 days after acute MI in patients with previously unknown diabetes. The researchers also examined the effect of newly diagnosed diabetes on 3-year mortality of MI and differences between men and women in the prevalence of abnormal glucose metabolism.

“If you look at patient characteristics, you can see what you typically see in registries in acute coronary syndrome or MI: that females are older,” Gitt said, noting that there was about an 8-year difference between men and women in the registry. “You can also see that there are differences in concomitant diseases, and you can see that already 30% of females had known diabetes, as compared with 23% of the male population.”

Because women were older and had a higher prevalence of known diabetes, the researchers were interested in how many more patients would receive a new diagnosis of diabetes, Gitt said.

Overall, at the time of MI, women had a higher rate and longer duration of diabetes (10 years vs. 7 years). They also had a higher prevalence of newly diagnosed impaired glucose metabolism when compared with men. Using an oral glucose tolerance test, the researchers identified another 19.8% of women with manifest diabetes vs. 15.3% of men. However, an additional 18.1% of women vs. 23.3% of men had impaired glucose tolerance or impaired fasting glucose. Nevertheless, at 68%, women had a higher prevalence of combined already known and newly diagnosed pathologic glucose metabolism than men (60.5%).

Researchers found that 3-year mortality rates for women with newly diagnosed diabetes (30.5%) were similar to women with previously identified diabetes (30%). In addition, women experienced prior MI and percutaneous coronary intervention less frequently than men.

For more information:

Gitt AK. Abstract #15682. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16; Orlando, Fla.

Disclosure: Dr. Gitt received a research grant from Sanofi-Aventis.

SWEETHEART establishes that patieints with MIs have to be evaluated for diabetes: For example, if patients weren't evalualated for cholesterol values on admission, the cholesterol would have to be evaluated after several months because the MI would have the effect of lowering cholesterol and patients with elevated lipids would not be identified. Often this would never be obtained or obtained months later. Now, this is widely known and early evaluation of cholesterol is incoroporated into the guidelines for acute MIs. This study stresses that you have to identify that there may be a high incidence of diabetes but you have to go after it. Even if people are borderline, you have to do a stress test, i.e. a glucose tolerance test, to establish diabetes so it can be controlled better over the long term, and minimize all the risk factors for a recurrent MI. This just goes to the fact that for survivorship, you've got to get your risk factors all identified as soon as possible for best management.

– Ronald J. Krone, MD
Professor of Medicine
Cardiovascular Division, Washington University School of Medicine, St. Louis

Disclosure: Dr. Krone reports no relevant financial disclosures.

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