Duan Jian Gang, Chen Xiang Yan, Wang Li, Lau Alex, Wong Adrian, Thomas G Neil, Tomlinson Brian, Liu Roxanna, Chan Juliana C N, Leung Thomas W, Mok Vincent, Wong Ka Sing
Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
PLoS One. 2015 Apr 1;10(4):e0122031. doi: 10.1371/journal.pone.0122031. eCollection 2015.
Diabetic patients with acute coronary syndrome (ACS) are at higher risk of poor outcome than are non-diabetic patients with ACS. Few studies have focused on sex-related ACS incidence, ACS-related mortality or risk factors to affects sex specific ACS in Chinese with Type 2 diabetes mellitus (T2DM). Based on a hospital-based cohort of Chinese patients with T2DM, we aimed to investigate whether there was sex difference in ACS or ACS-related mortality or risk factors of ACS.
Totally 2,135 Hong Kong Chinese with T2DM were recruited during 1994-1996 and followed up until August 2012. We systematically analyzed sex-related ACS incidence and ACS-related mortality and risk factors with χ2-squared test, descriptive statistics and survival analysis.
Regular follow-up was completed in 2,105 subjects (98.6%), with a median period of 14.53 years. The occurrence of ACS was recorded among 414 patients (19.7%) and ACS-related death among 104 patients (4.9%). ACS incidences increased with age in both men and women, and men had a higher prevalence of ACS than women across different age categories and different follow-up periods (log rank χ2=20.32, P<0.001). The transition of ACS incidences from slow to rapid increase were about 5 years earlier in men (at 51-55 years) than in women (55-60 years). Among ACS patients, cumulative ACS-related mortalities was similar between men and women (log rank χ2=0.063, P=0.802). Besides age and albuminuria, different profiles of risk factors accounted for the occurrence of ACS between men and women.
Our findings demonstrated sex differences in ACS incidence and risk factors, but not in ACS-related mortality in Chinese patients withT2DM. These findings suggest that screening and prevention campaigns should be optimized for men and women, which may help to identify diabetic patients at higher risk of coronary heart disease.
与非糖尿病急性冠状动脉综合征（ACS）患者相比，糖尿病ACS患者预后不良的风险更高。很少有研究关注2型糖尿病（T2DM）中国患者中与性别相关的ACS发病率、ACS相关死亡率或影响特定性别的ACS的危险因素。基于一个以医院为基础的中国T2DM患者队列，我们旨在研究ACS、ACS相关死亡率或ACS危险因素是否存在性别差异。
1994年至1996年共招募了2135名中国香港T2DM患者，并随访至2012年8月。我们用卡方检验、描述性统计和生存分析系统地分析了与性别相关的ACS发病率、ACS相关死亡率和危险因素。
2105名受试者（98.6%）完成了定期随访，中位随访时间为14.53年。414例患者（19.7%）记录了ACS的发生，104例患者（4.9%）记录了ACS相关死亡。男性和女性的ACS发病率均随年龄增加，在不同年龄组和不同随访期，男性的ACS患病率均高于女性（对数秩卡方=20.32，P<0.001）。男性ACS发病率从缓慢上升到快速上升转变的时间（51-55岁）比女性（55-60岁）早约5年。在ACS患者中，男性和女性的累积ACS相关死亡率相似（对数秩卡方=0.063，P=0.802）。除年龄和蛋白尿外，男性和女性ACS发生的危险因素谱不同。
我们的研究结果表明，中国T2DM患者在ACS发病率和危险因素方面存在性别差异，但在ACS相关死亡率方面不存在性别差异。这些发现表明，应针对男性和女性优化筛查和预防措施，这可能有助于识别冠心病风险较高的糖尿病患者。
