Sex Differences in Coronary Artery Disease Patients With and in Those Without Type 2 Diabetes

Life-term cardiovascular risk is high also in women, and women with coronary artery disease (CAD) or with type 2 diabetes (T2DM) are at a particularly high risk. In this prospective cohort study, we addressed sex differences in CAD patients with as well in those without T2DM. We recorded cardiovascular events in an unselected consecutive series of 1472 patients with angiographically proven CAD over 7.5±2.9 years. T2DM prevelance was similar in men (n=1060) and women (27.3 vs. 30.1%; p=0.277). Among nondiabetic CAD patients women were older than men (68±9 vs. 63±11 years; p<0.001), had higher LDL cholesterol (138±42 vs. 130±38 mg/dl; p=0.022) and HDL cholesterol (63±16 vs. 51±14 mg/dl; p<0.001) and a lower prevelance of smoking (35.5 vs. 69.6%; p<0.001) and of prior myocardial infarction (20.6 vs. 31.2%; p=0.001). Among those with T2DM, women also were older (69±9 vs. 64±10 years; p<0.001), had higher HDL cholesterol (53±14 vs. 46±13 mg/dl; p<0.001) and a lower prevalence of smoking (28.6 vs. 80.1%; p<0.001); further among those with T2DM the prevelance of hypertension (79.9 vs. 70.7%; p=0.049) and of statin use (66.9 vs. 48.3%; p<0.001) was higher in women. Prospectively, sex did not predict cardiovascular events in CAD patients without nor in those with T2DM, with adjusted hazard ratios of 0.96 [0.73-1.26]; p=0.757 and 0.82 [0.55-1.22]; p=0.329, respectively. We conclude that baseline risk factors both among CAD patients without and among those with T2DM differ between women and men, whereas irrespective of diabetes status sex does not affect the incidence of future cardiovascular events in this population.