Age-dependent differences in diabetes and acute hyperglycemia between men and women with ST-elevation myocardial infarction: a cohort study

Background: Both acute hyperglycemia as diabetes results in an impaired prognosis in ST-elevation myocardial infarction (STEMI) patients. It is unknown whether there is a different prevalence of diabetes and acute hyperglycemia in men and women within age-groups. Methods: Between 2004 and 2010, 4640 consecutive patients (28% women) with STEMI, were referred for primary PCI. Patients were stratified into two age groups, < 65 years (2447 patients) and ≥65 years (2193 patients). Separate analyses were performed in 3901 patients without diabetes. Diabetes was defined as known diabetes or HbA1c ≥6.5 mmol/l at admission. Results: The prevalence of diabetes was comparable between women and men in the younger age group (14% vs 12%, p=0.52), whereas in the older age group diabetes was more prevalent in women (25% vs 17% p<0.001). In patients without diabetes, admission glucose was comparable between both genders in younger patients (8.1±2.0 mmol/l vs 8.0±2.2 mmol/l p =0.36), but in older patients admission glucose was higher in women than in men (8.7± 2.1 mmol/l vs 8.4±2.1 mmol/l p =0.028). After multivariable analyses, the occurrence of increased admission glucose was comparable between men and women in the younger age group (OR 1.1, 95%CI 0.9-1.5), but increased in women in the older age group (OR 1.3, 95% CI 1.1-1.7). Both diabetes and hyperglycemia were associated with a higher oneyear mortality in both men and women. Conclusions: The differences between men and women in hyperglycemia and diabetes in patients with STEMI are age dependent and can only be observed in older patients. This may have implications for medical treatment and should be investigated further.