Ferrannini Giulia, Maldonado Juan M, Raha Sohini, Rao-Melacini Purnima, Khatun Rutaba, Atisso Charles, Shurzinske Linda, Gerstein Hertzel C, Rydén Lars, Bethel M Angelyn
Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Eli Lilly Export S.A, San Juan, Puerto Rico.
Scand Cardiovasc J. 2023 Dec;57(1):2166101. doi: 10.1080/14017431.2023.2166101.
. To assess whether the use of cardioprotective therapies for type 2 diabetes varies by gender and whether the risk of cardiovascular events is higher in women versus men in the REWIND trial, including an international type 2 diabetes patient population with a wide range of baseline risk. . Gender differences in baseline characteristics, cardioprotective therapy, and the achieved clinical targets at baseline and two years were analyzed. Hazards for cardiovascular outcomes (fatal/nonfatal stroke, fatal/nonfatal myocardial infarction, cardiovascular death, all-cause mortality, and heart failure hospitalization), in women versus men were analyzed using two Cox proportional hazard models, adjusted for randomized treatment and key baseline characteristics respectively. Time-to-event analyses were performed in subgroups with or without history of cardiovascular disease using Cox proportional hazards models that included gender, subgroup, randomized treatment, and gender-by-subgroup interactions. . Of 9901 participants, 46.3% were women. Significantly fewer women than men had a cardiovascular disease history. Although most women met treatment targets for blood pressure (96.7%) and lipids (72.8%), fewer women than men met the target for cardioprotective therapies at baseline and after two years, particularly those with prior cardiovascular disease, who used less renin-angiotensin-aldosterone system inhibitors, statins, and aspirin than men. Despite these differences, women had lower hazards than men for all outcomes except stroke. No significant gender and cardiovascular disease history interactions were identified for cardiovascular outcomes. . In REWIND, most women met clinically relevant treatment targets, but in lower proportions than men. Women had a lower risk for all cardiovascular outcomes except stroke. .
在一项纳入了具有广泛基线风险的国际2型糖尿病患者群体的REWIND试验中，评估2型糖尿病心脏保护疗法的使用是否因性别而异，以及女性与男性相比心血管事件风险是否更高。分析了基线特征、心脏保护疗法以及基线和两年时所达到的临床目标方面的性别差异。使用两个Cox比例风险模型分别对随机治疗和关键基线特征进行校正后，分析了女性与男性心血管结局（致命性/非致命性中风、致命性/非致命性心肌梗死、心血管死亡、全因死亡率和心力衰竭住院）的风险。使用包含性别、亚组、随机治疗以及性别与亚组交互作用的Cox比例风险模型，对有或无心血管疾病史的亚组进行了事件发生时间分析。990名参与者中，46.3%为女性。有心血管疾病史的女性明显少于男性。尽管大多数女性达到了血压（96.7%）和血脂（72.8%）的治疗目标，但在基线和两年后达到心脏保护疗法目标的女性少于男性，尤其是那些有心血管疾病史的女性，她们使用肾素-血管紧张素-醛固酮系统抑制剂、他汀类药物和阿司匹林的比例低于男性。尽管存在这些差异，但除中风外，女性在所有结局方面的风险均低于男性。未发现心血管结局存在显著的性别与心血管疾病史交互作用。在REWIND试验中，大多数女性达到了临床相关治疗目标，但比例低于男性。除中风外，女性在所有心血管结局方面的风险较低。
