Cardiovascular disease in women: what's different? What's new? What's unresolved?

Ethnicity influences cardiovascular outcomes and complications in patients with type 2 diabetes

AIM

To determine whether cardiovascular outcomes in type 2 diabetes (T2D) differ according to ethnicity, and whether ethnicity influences the effect of gender on these outcomes in Caucasians, East-Southeast-Asians, Middle-Easterners, South-Asians and Pacific-Islanders.

METHODS

We compared demographics, HbA1c, lipid profile, renal function markers, and prevalence of macrovascular and microvascular complications between ethnic groups. Cross-sectional data was prospectively collected from 204 consecutive patients at Westmead Hospital's T2D clinic from April-October 2015. Univariate analysis was performed using chi-squared test for categorical data, and Mann-Whitney-U or Kruskal-Wallis test for continuous data.

RESULTS

Compared to Caucasians, South-Asians were diagnosed younger, were currently younger, had lower body-mass-index (BMI) and better renal function but higher rates of non-ST-elevation myocardial infarction (STEMI, 21.7% versus 3.5%, p<0.05). East-Southeast-Asians had lower BMI but more nephropathy than Caucasians (59% versus 39%, p<0.05). East-Southeast-Asian males had fewer CVD than Caucasians, but this protection was absent in East-Southeast-Asian females. Middle-Easterners had more non-STEMI than Caucasians (5.3% vs 3.5%, p<0.05). Middle-Eastern females were not at lower CVD risk than males. Caucasians had most PVD (20% versus 6%, p<0.05).

CONCLUSIONS

Ethnicity influences rates of diabetes-related complications. Female CVD protection is altered in some groups. Ethnicity should be considered in assessing CVD and complications risk.

Prospective Analysis of More than 1,000 Patients with Rectal Carcinoma: Are There Gender-Related Differences?

Background

Since the beginning of the new millennium gender medicine has become more and more relevant. The goal has been to unveil differences in presentation, treatment response, and prognosis of men and women with regard to various diseases.

Methods

This study encompassed 1,061 patients who underwent surgery for rectal cancer at the Department of Surgery, University Medical Center Schleswig-Holstein Campus Lübeck, Germany, between January 1990 and December 2011. Prospectively documented demographic, clinical, pathological, and follow-up data were obtained. Analysis encompassed the comparison of clinical, histopathological, and oncological parameters with regard to the subcohorts of male and female patients.

Results

No statistically significant differences could be found for clinical and histopathological parameters, location of tumor, resection with or without anastomosis, palliative or curative treatment, conversion rates, duration of surgery, and long-term survival. For the entire cohort, gender-related statistically significant differences in complications encompassed anastomotic leakage, burst abdomen, pneumonia, and urinary tract complications all of which occurred more often in men.

Conclusion

Data obtained in this study suggest that there are no gender-related differences in the oncologic surgical treatment of patients with rectal carcinoma. However, male sex seems to be a risk factor for increased early postoperative morbidity.

Diabetes as a risk factor for myocardial infarction: population and gender perspectives

OBJECTIVES

To investigate diabetes as a risk factor for acute myocardial infarction (AMI) from a population perspective in a region with high cardiovascular disease (CVD) risk.

DESIGN

Population screenings for diabetes and a population-based AMI register.

SETTING

Northern Sweden MONICA area.

SUBJECTS

Representative sample (Norrbotten and Västerbotten counties) of 2432 men and women 35-64 years was investigated 1990 and 1994. All patients with AMI aged 35-64 years were included, in total 3031 between 1989 and 1993.

RESULTS

The prevalence of diabetes was 5% in men and 4.4% in women. The relative risk (RR) in diabetic men was 2.9; 95% confidence interval (CI) 2.6-3.4, and in diabetic women, RR 5.0; CI 3.9-6.3. The risk for re-infarction was about twice as large in patients with diabetes as in patients without diabetes. In both sexes the overall 28 day case fatality (CF) was significantly higher in diabetic compared to non-diabetic subjects. When compared to the non-diabetic population, the overall mortality from AMI in the diabetic population was 4 times higher among men and 7 times higher among women. The population attributable risk (PAR), a crude estimate of all AMIs ascribed to diabetes, was 11% in men and 17% in women.

CONCLUSIONS

Diabetes increases the risk for AMI attack rate, incidence, case-fatality, recurrence and mortality and is an important contributor to all AMIs in middle-aged people.