Women Without Diabetes Fare as Poorly as Diabetic Men Post-PCI

Women with diabetes represent one of the highest-risk groups for adverse events after PCI. But a new study highlights something even more unsettling: even if they’re not diabetic, women have a risk of ischemic events equivalent to that of diabetic men.

“Everybody knows that diabetes is an important risk factor for any vascular event,” study co-author Annapoorna Kini, MD (Icahn School of Medicine at Mount Sinai, New York, NY), told TCTMD. “Our study shows that even if you take diabetes out of the equation, being a woman itself is an added risk factor.”

Kini said one of the main takeaway messages of the study is that women need to begin taking care of themselves at an earlier age. “By 65, 70 years of age, maybe it’s too late to start thinking about taking care of yourself,” she observed. “We need to be reaching women who are postmenopausal and encouraging screening and lifestyle changes at that time.”

A Growing Picture of Inequality

The registry study, led by Serdar Farhan, MD (Icahn School of Medicine at Mount Sinai), and published online last week in the American Journal of Cardiology, compared 1-year outcomes in more than 17,000 women and men with and without diabetes who underwent PCI with at least one stent between 2009 and 2014.

Most of the women were elderly and about 3 to 5 years older, on average, than men with or without diabetes. They also had comorbidity rates that in most cases were as high, if not higher, than those of their male counterparts. Female patients more likely to be treated with insulin and to have higher HbA1c and CRP levels regardless of their diabetes status.

Compared with nondiabetic men, women with diabetes had higher risk of death (adjusted HR 1.67; 95% CI 1.28-2.17), MI (adjusted HR 1.67; 95% CI 1.28-2.17), and the combined outcome of death and MI (adjusted HR 1.37; 95% CI 1.19-1.58). At the same time, women without diabetes had equivalent rates of death (adjusted HR 3.08% vs 2.93%; P = 0.69) and MI compared with men who did have diabetes (adjusted HR 3.99% vs 3.71%; P = 0.97).

Unlike many clinical trials, the registry included large numbers of minority men and women, which Kini and colleagues say add to the generalizability of their findings to the real-world PCI population.

“The studies are consistent that women, when they come in for PCI, do poorly because they have so many concomitant risk factors,” Kini noted. “But women, especially minorities, are poorly represented in every trial and that has been a reason why we don’t know [as much] about how they compare with men in this regard.”

Recent registry studies suggest that while PCI is responsible for reductions in CAD-related mortality, women clearly are not benefiting as much as men from these reductions, Kini et al observe.

One thing women with CAD need is more comprehensive treatment, regardless of whether or not they have diabetes, the researchers suggest. Large trials such as CRUSADE have shown that women are less likely than men to receive guideline-recommended treatment.

“It may be that more studies are necessary that focus just on women,” Kini said, adding that such data could potentially influence guidelines and help increase the visibility of women’s risk.

Note: Study co-authors Roxana Mehran, MD, and George Dangas, MD, PhD, are faculty members of the Cardiovascular Research Foundation, the publisher of TCTMD.