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Díez-Villanueva P, García-Acuña JM, Raposeiras-Roubin S, Barrabés JA, Cordero A, Martínez-Sellés M, Bardají A, Marín F, Ruiz-Nodar JM, Vicente-Ibarra N, Alonso Salinas GL, Cid-Alvárez B, Abu Assi E, Formiga F, Núñez J, Núñez E, Ariza-Solé A, Sanchis J. Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome. J Clin Med 2021; 10:jcm10194403. [PMID: 34640420 PMCID: PMC8509190 DOI: 10.3390/jcm10194403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 01/30/2023] Open
Abstract
Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.
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Affiliation(s)
| | - Jose María García-Acuña
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, CIBERCV, 15706 Santiago de Compostela, A Coruña, Spain; (J.M.G.-A.); (B.C.-A.)
| | - Sergio Raposeiras-Roubin
- Servicio de Cardiología, Hospital Álvaro Cunqueiro de Vigo, 36213 Vigo, Pontevedra, Spain; (S.R.-R.); (E.A.A.)
| | - Jose A. Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, CIBERCV, 08035 Barcelona, Spain;
| | - Alberto Cordero
- Servicio de Cardiología, Hospital Clínico Universitario de San Juan, 03550 Alicante, Spain;
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, 28007 Madrid, Spain;
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, 43005 Tarragona, Spain;
| | - Francisco Marín
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, 30120 Murcia, Spain;
| | - Juan M. Ruiz-Nodar
- Servicio de Cardiología, Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | | | - Gonzalo L. Alonso Salinas
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal de Madrid, CIBERCV, 28034 Madrid, Spain;
| | - Belén Cid-Alvárez
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, CIBERCV, 15706 Santiago de Compostela, A Coruña, Spain; (J.M.G.-A.); (B.C.-A.)
| | - Emad Abu Assi
- Servicio de Cardiología, Hospital Álvaro Cunqueiro de Vigo, 36213 Vigo, Pontevedra, Spain; (S.R.-R.); (E.A.A.)
| | - Frances Formiga
- Servicio de Medicina Interna, Hospital Bellvitge, L’Hospitalet de Llobregat, 08097 Barcelona, Spain;
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46014 Valencia, Spain; (J.N.); (E.N.)
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46014 Valencia, Spain; (J.N.); (E.N.)
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L’Hospitalet de Llobregat, 08097 Barcelona, Spain;
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46014 Valencia, Spain; (J.N.); (E.N.)
- Correspondence:
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Migliore L, Nicolì V, Stoccoro A. Gender Specific Differences in Disease Susceptibility: The Role of Epigenetics. Biomedicines 2021; 9:652. [PMID: 34200989 PMCID: PMC8228628 DOI: 10.3390/biomedicines9060652] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 01/08/2023] Open
Abstract
Many complex traits or diseases, such as infectious and autoimmune diseases, cancer, xenobiotics exposure, neurodevelopmental and neurodegenerative diseases, as well as the outcome of vaccination, show a differential susceptibility between males and females. In general, the female immune system responds more efficiently to pathogens. However, this can lead to over-reactive immune responses, which may explain the higher presence of autoimmune diseases in women, but also potentially the more adverse effects of vaccination in females compared with in males. Many clinical and epidemiological studies reported, for the SARS-CoV-2 infection, a gender-biased differential response; however, the majority of reports dealt with a comparable morbidity, with males, however, showing higher COVID-19 adverse outcomes. Although gender differences in immune responses have been studied predominantly within the context of sex hormone effects, some other mechanisms have been invoked: cellular mosaicism, skewed X chromosome inactivation, genes escaping X chromosome inactivation, and miRNAs encoded on the X chromosome. The hormonal hypothesis as well as other mechanisms will be examined and discussed in the light of the most recent epigenetic findings in the field, as the concept that epigenetics is the unifying mechanism in explaining gender-specific differences is increasingly emerging.
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Affiliation(s)
- Lucia Migliore
- Department of Translational Research and of New Surgical and Medical Technologies, Medical School, University of Pisa, 56126 Pisa, Italy; (V.N.); (A.S.)
- Department of Laboratory Medicine, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy
| | - Vanessa Nicolì
- Department of Translational Research and of New Surgical and Medical Technologies, Medical School, University of Pisa, 56126 Pisa, Italy; (V.N.); (A.S.)
| | - Andrea Stoccoro
- Department of Translational Research and of New Surgical and Medical Technologies, Medical School, University of Pisa, 56126 Pisa, Italy; (V.N.); (A.S.)
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