Gender and Risk of Cardiovascular Events in Patients with Diabetic Foot

In patients with diabetic foot (DF) the risk of developing cardiovascular events or renal failure is strongly increased. While DF is more frequent in males, it is yet unknown if there is a gender difference about cardiovascular events or renal failure incidence in patients with diabetic foot. The aim of this study was to evaluate the risk of hospitalization for cardiovascular events (ASCVD: heart attack, ischemic stroke or heart failure) or chronic renal failure (CKD), stratified by gender, in a population of diabetic patients living in Tuscany from 2012 to 2016. On the basis of administrative data bases, patients living in Tuscany at the 1st of January 2012 were divided into 2 subgroups: patients previously hospitalized for diabetic foot (ulcers, infections, major or minor amputations, gangrene or Charcot foot) and patients without history of hospitalization for diabetic foot. Data were collected from the regional hospitalization registry, and in the two groups the risk of developing ASCVD or CKD by the Cox regression corrected by age and comorbidities (Charlson Index of previous hospitalizations) separately in males and females was evaluated. 240238 patients with diabetes (121442 males, 118796 females) were identified. After the corrections made by age, sex and Charlson index, males showed a major risk of developing diabetic foot (DF): Odds Ratio (OR):2.018 (95% CI:1.901-2.141); p<0.0001.The corrected risk of hospitalization for ASCVD and CKD in patients with previous diagnosis of DF was higher in females [Hazard Ratio (HR):1.647 (1.470-1838)] than in males (HR:1.458 (1.348-1.574); p=0,04. In the population investigated, the risk of hospitalization for DF was two time higher in males, while, the risk of hospitalization for ASCVD corrected by confounding factors, in patients previously hospitalized for DF, was significantly higher in females.