Diabetic women and patients with
insulin-dependent diabetes mellitus (IDDM) are at greater risk of cardiac death
than other diabetic patients.
Furthermore, there
appears to be no gender bias in identifying those at high risk of cardiac
mortality when testing is performed using adenosine myocardial perfusion
single-photon emission computed tomography (MPS).
Dr. Daniel S. Berman,
of Cedars-Sinai Medical Center in Los Angeles, and colleagues analyzed
prospectively collected data for 2656 women and 2677 men with suspected or known
coronary artery disease (CAD). The subjects were followed for more than a year
after undergoing rest thallium-201/adenosine technetium-99m sestamibi MPS.
During a mean
follow-up of 27 months, cardiac death rate was 4.4% in women and 6.1% in men.
Multivariate analysis showed that nondiabetic men and women had similar risk,
1.6% for those with mild abnormalities and 6.1% for severe abnormalities.
However, among those patients with severe abnormalities, women with diabetes
were at greater risk than diabetic men, at 8.5% and 6.0%, respectively.
For any degree of
summed stress score abnormality, patients with diabetes had a higher event rate
than nondiabetics, and those with IDDM were at higher risk than those with NIDDM,
the report indicates.
This study is the
first to show an increased risk of death for any MPS scan result in insulin
dependent patients and that female diabetes are a higher risk than diabetic men
in each category of scan finding.
Dr. Berman stated that "Our findings in both diabetics and non-diabetics show that adenosine MPS can be very effective in establishing mortality risk in patients who are unable to exercise and in helping determine who needs the most aggressive therapy," he added.
Source: Diabetes In Control Dot Com:
J Am Coll Cardiol 2003;41:1125-1133.
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