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Lv Y, Li K, Wang S, Wang X, Yue G, Zhang Y, Lv X, Zhao P, Wang S, Zhang Q, Li Q, Zhu J, Li J, Peng P, Li Y, Luo J, Zhang X, Yang J, Zhang B, Wang X, Zhang M, Shen C, Wang X, Wang M, Ye Z, Cui Y. Protective role of arachidonic acid against diabetic myocardial ischemic injury: a translational study of pigs, rats, and humans. Cardiovasc Diabetol 2024; 23:58. [PMID: 38336692 PMCID: PMC10858581 DOI: 10.1186/s12933-024-02123-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/05/2024] [Indexed: 02/12/2024] Open
Abstract
AIM Patients with diabetes mellitus have poor prognosis after myocardial ischemic injury. However, the mechanism is unclear and there are no related therapies. We aimed to identify regulators of diabetic myocardial ischemic injury. METHODS AND RESULTS Mass spectrometry-based, non-targeted metabolomic approach was used to profile coronary sinus blood from diabetic and non-diabetic Bama-mini pigs at 0.5-h post coronary artery ligation. Six metabolites had a |log2 (Fold Change)|> 1.3. Among them, the most changed is arachidonic acid (AA), levels of which were 32 times lower in diabetic pigs than in non-diabetic pigs. The AA-derived products, PGI2 and 6-keto-PGF1α, were also significantly reduced. AA treatment of cultured cardiomyocytes protected against cell death by 30% at 48 h of high glucose and oxygen deprivation, which coincided with increased mitophagic activity (as indicated by increased LC3II/LC3I, decreased p62 and increased parkin & PINK1), improved mitochondrial renewal (upregulation of Drp1 and FIS1), reduced ROS generation and increased ATP production. These cardioprotective effects were abolished by PINK1(a crucial mitophagy protein) knockdown or the autophagy inhibitor 3-Methyladenine. The protective effect of AA was also inhibited by indomethacin and Cay10441, a prostacyclin receptor antagonist. Furthermore, diabetic Sprague Dawley rats were subjected to coronary ligation for 40 min and AA treatment (10 mg/day per animal gavaged) decreased myocardial infarct size, cell apoptosis index, inflammatory cytokines and improved heart function. Scanning electron microscopy showed more intact mitochondria in the border zone of infarcted myocardium in AA treated rats. Lastly, diabetic patients after myocardial infarction had lower plasma levels of AA and 6-keto-PGF1α and reduced cardiac ejection fraction, compared with non-diabetic patients after myocardial infarction. Plasma AA level was inversely correlated with fasting blood glucose. CONCLUSIONS AA protects against diabetic ischemic myocardial damage by promoting mitochondrial autophagy and renewal, which is related to AA derived PGI2 signaling. AA may represent a new strategy to treat diabetic myocardial ischemic injury.
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Affiliation(s)
- Yunhui Lv
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Kai Li
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Shuo Wang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xiaokang Wang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Guangxin Yue
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yangyang Zhang
- Department of Pharmacy & Cardiology & Endocrinology & General Surgery, Suqian First Hospital, 120 Suzhi Road, Sucheng District, Suqian, 223800, Jiangsu, China
| | - Xin Lv
- Department of Pharmacy & Cardiology & Endocrinology & General Surgery, Suqian First Hospital, 120 Suzhi Road, Sucheng District, Suqian, 223800, Jiangsu, China
| | - Ping Zhao
- Department of Pharmacy & Cardiology & Endocrinology & General Surgery, Suqian First Hospital, 120 Suzhi Road, Sucheng District, Suqian, 223800, Jiangsu, China
| | - Shiping Wang
- Department of Pharmacy & Cardiology & Endocrinology & General Surgery, Suqian First Hospital, 120 Suzhi Road, Sucheng District, Suqian, 223800, Jiangsu, China
| | - Qi Zhang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Qiuju Li
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jinyan Zhu
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jubo Li
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Peng Peng
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yue Li
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jiafei Luo
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xue Zhang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jianzhong Yang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Baojie Zhang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xuemin Wang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Min Zhang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chen Shen
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xin Wang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Miao Wang
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Zhen Ye
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
- Department of Pharmacy & Cardiology & Endocrinology & General Surgery, Suqian First Hospital, 120 Suzhi Road, Sucheng District, Suqian, 223800, Jiangsu, China.
| | - Yongchun Cui
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
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2
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Yaow CYL, Chong B, Chin YH, Kueh MTW, Ng CH, Chan KE, Tang ASP, Chung C, Goh R, Kong G, Muthiah M, Sukmawati I, Lukito AA, Chan MY, Khoo CM, Mehta A, Mamas MA, Dimitriadis GK, Chew NWS. Higher risk of adverse cardiovascular outcomes in females with type 2 diabetes Mellitus: an Umbrella review of systematic reviews. Eur J Prev Cardiol 2023; 30:1227-1235. [PMID: 37185913 DOI: 10.1093/eurjpc/zwad133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/20/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have excess mortality risk compared to their male counterparts. An important next step to address the high global burden of T2DM and cardiovascular disease (CVD) is an umbrella review to summarize data on sex differences in cardiovascular outcomes for patients with T2DM and assess the strength of the evidence observed. METHODS AND RESULTS Medline and Embase were searched from inception till 7 August 2022 for systematic reviews and meta-analyses studying the effects of sex on cardiovascular outcomes in T2DM patients. Results from reviews were synthesized with a narrative synthesis, with a tabular presentation of findings and forest plots for reviews that performed a meta-analysis. 27 review articles evaluating sex differences in cardiovascular outcomes were included. Females with T2DM had a higher risk of developing coronary heart disease (CHD; RRR: 1.52, 95%CI: 1.32-1.76, P < 0.001), acute coronary syndrome (ACS; RRR: 1.38, 95%CI: 1.25-1.52, P < 0.001), heart failure (RRR: 1.09, 95%CI: 1.05-1.13, P < 0.001) than males. Females had a higher risk of all-cause mortality (RRR: 1.13, 95%CI: 1.07-1.19, P < 0.001), cardiac mortality (RRR: 1.49, 95%CI: 1.11-2.00, P = 0.009) and CHD mortality (RRR: 1.44, 95%CI: 1.20-1.73, P < 0.001) as compared to males. CONCLUSIONS This umbrella review demonstrates that females with T2DM have a higher risk of cardiovascular outcomes than their male counterparts. Future research should address the basis of this heterogeneity and epidemiological factors for better quality of evidence, and identify actionable interventions that will narrow these sex disparities.
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Affiliation(s)
- Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Martin Tze Wah Kueh
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland
- University College Dublin Malaysia Campus, George Town, Malaysia
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Charlotte Chung
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Rachel Goh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Indah Sukmawati
- Cardiovascular Department, Siloam Hospitals Lippo Village, Pelita Harapan University, Tangerang, Indonesia
| | - Antonia Anna Lukito
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mamas A Mamas
- Institute of Population Health, University of Manchester, Manchester, UK
- Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Georgios K Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, London SE1 9RT, UK
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
- Cardiovascular Department, Siloam Hospitals Lippo Village, Pelita Harapan University, Tangerang, Indonesia
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Liu Y, Gao Y, Liu H, Chen Q, Ji J, Jia K. Therapeutic Effects of Triple Antiplatelet Therapy in Elderly Female Patients with Diabetes and Acute Myocardial Infarction. Arq Bras Cardiol 2021; 116:229-235. [PMID: 33470329 PMCID: PMC7909981 DOI: 10.36660/abc.20190442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/27/2019] [Indexed: 11/18/2022] Open
Abstract
Fundamento A dupla antiagregação plaquetária (DAP) é o tratamento fundamental do infarto agudo do miocárdio (IAM). Objetivo O presente estudo visou investigar a eficácia e a segurança da tripla antiagregação plaquetária (TAP) em pacientes femininas idosas com diabetes e infarto agudo do miocárdio com supradesnível do segmento ST (IAMCSST), que foram submetidas à intervenção coronária percutânea ICP. Métodos Trata-se se de um estudo randomizado e mono-cego. O grupo controle A (97 pacientes idosos do sexo masculino com diabetes e STEMI, cujos escores CRUSADE foram < 30) recebeu aspirina, ticagrelor e tirofibana. Um total de 162 pacientes femininas idosas com diabetes e IAMCSST foram divididas aleatoriamente em dois grupos de acordo com o escore CRUSADE. O grupo B (69 pacientes com escore CRUSADE > 31) recebeu aspirina e ticagrelor. O grupo C (93 pacientes com escore CRUSADE < 30) recebeu aspirina, ticagrelor e tirofibana. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados Após a PCI, o fluxo sanguíneo grau 3
Thrombolysis in Myocardial Infarction
(TIMI) e a perfusão miocárdica TIMI grau 3 foram significativamente menos prevalentes no grupo B, em comparação com o grupo A (p < 0,05). Quando comparada aos grupos A e C, a incidência de complicações adversas maiores foi significativamente maior no grupo B (p < 0,05). Conclusão A TAP pode efetivamente reduzir a incidência de complicações maiores em pacientes idosas com diabetes e IAMCSST. No entanto, atenção cuidadosa deve ser dada à hemorragia em pacientes que recebem TAP. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
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Affiliation(s)
- Yang Liu
- Affiliated People's Hospital of Zhengzhou,The Second School of Clinical Medicine,Southern Medical University, Zhengzhou - China
| | - Yanyan Gao
- Shenqiu County Hospital of Traditional Chinese Medicine, Shenqiu - China
| | - Hengliang Liu
- Affiliated People's Hospital of Zhengzhou,The Second School of Clinical Medicine,Southern Medical University, Zhengzhou - China
| | - Qi Chen
- Affiliated People's Hospital of Zhengzhou,The Second School of Clinical Medicine,Southern Medical University, Zhengzhou - China
| | - Jinrui Ji
- Affiliated People's Hospital of Zhengzhou,The Second School of Clinical Medicine,Southern Medical University, Zhengzhou - China
| | - Kailong Jia
- Affiliated People's Hospital of Zhengzhou,The Second School of Clinical Medicine,Southern Medical University, Zhengzhou - China
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Song S, Wu S, Wang Y, Wang Z, Ye C, Song R, Song D, Ruan Y. 17β-estradiol inhibits human umbilical vascular endothelial cell senescence by regulating autophagy via p53. Exp Gerontol 2018; 114:57-66. [PMID: 30399406 DOI: 10.1016/j.exger.2018.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 12/13/2022]
Abstract
Vascular endothelial cell (VEC) senescence is an initiating factor in numerous cardiovascular diseases. Recent studies showed that 17β-estradiol (17β-E2), an estrogen with numerous biological activities such as inhibition of atherosclerosis, protects VECs from senescence. However, the effects of 17β-E2 on human umbilical VECs (HUVECs) remain unknown. This study investigated the anti-senescent effect of 17β-E2 on HUVECs and explored the underlying mechanism with respect to autophagy and p53 activity. First, rapamycin and 3-methyladenine were used to clarify the relationship between autophagy and senescence in HUVECs, and an inverse relationship was demonstrated. Next, the effect of 17β-E2 on H2O2-induced senescence of HUVECs was examined. Increased autophagy induced by 17β-E2 inhibited H2O2-induced senescence of HUVECs, increased cell viability, and maintained HUVEC morphology. 17β-E2 pre-treatment also decreased cell cycle arrest, decreased the dephosphorylation of Rb, decreased the production of ET-1, and increased the production of NO. Most importantly, 17β-E2 pre-treatment increased autophagy by activating p53 and its downstream effector p53-upregulated modulator of apoptosis (PUMA). Overall, our data indicate the critical role of autophagy in the anti-senescent effect of 17β-E2 on HUVECs.
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Affiliation(s)
- Shicong Song
- Department of Gerontology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Saizhu Wu
- Department of Gerontology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuyan Wang
- Department of Gerontology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiwei Wang
- Department of Gerontology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Changxiong Ye
- Department of Gerontology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rui Song
- Department of Gerontology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dongqing Song
- Department of Gerontology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunjun Ruan
- Department of Gerontology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Bundhun PK, Pursun M, Huang F. Are women with type 2 diabetes mellitus more susceptible to cardiovascular complications following coronary angioplasty?: a meta-analysis. BMC Cardiovasc Disord 2017; 17:207. [PMID: 28750607 PMCID: PMC5530915 DOI: 10.1186/s12872-017-0645-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/24/2017] [Indexed: 12/26/2022] Open
Abstract
Background Scientific reports have shown Type 2 Diabetes Mellitus (T2DM) to be independently associated with adverse outcomes following Percutaneous Coronary Intervention (PCI). However, gender difference has also often been a controversial issue following PCI. Till date, very few meta-analyses have systematically compared the adverse cardiovascular outcomes in male versus female patients with T2DM following PCI. Therefore, we aimed to carry out this analysis in order to find out an answer to this interesting question. Methods Electronic databases were searched for English language publications reporting adverse cardiovascular outcomes in male versus female patients with diabetes mellitus respectively following coronary angioplasty. The RevMan 5.3 software was used to analyze selected adverse cardiovascular events whereby Odds Ratios (OR) and 95% Confidence Intervals (CI) were the statistical parameters. Results A total number of 19,304 patients with T2DM (12,986 male patients versus 6318 female patients) were included in this analysis. At baseline, female patients were older (68.7 versus 62.9 years), with a higher percentage of hypertension (75.6% versus 66.5%) and dyslipidemia (53.3% versus 50.0%) whereas majority of the male patients were smokers (46.3% versus 14.9%). Results of this analysis showed short and long-term mortality to be significantly higher in female patients with T2DM (OR: 1.71, 95% CI: 1.46–2.00; P = 0.00001), and (OR: 1.20, 95% CI: 1.07–1.35; P = 0.002) respectively. In addition, women were also more at risk for short and long-term major adverse cardiac events (MACEs) with OR: 1.49, 95% CI: 1.07–2.07; P = 0.02 and OR: 1.15, 95% CI: 1.04–1.28; P = 0.009 respectively. Subgroup analysis showed this significant result to have mainly been observed in patients with acute myocardial infarction compared to those with stable coronary artery disease. Conclusions Following PCI, women with T2DM were indeed more susceptible to short and long-term cardiovascular complications compared to male patients with the same chronic disease. Even though this result was more applicable to patients with acute myocardial infarction, the fact that women were older with higher co-morbidities at baseline compared to men, should also not be ignored.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China
| | - Manish Pursun
- Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China
| | - Feng Huang
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China.
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