Sex Does Not Influence Prognosis in Diabetic Patients. The Barbanza Diabetes Study

Introduction and objectivesTo determine the influence of sex on cardiovascular complications in diabetic patients.MethodsThis multicenter prospective cohort study involved 1423 consecutive patients with diabetes mellitus who were recruited during consultations with 31 primary care physicians. The patients’ characteristics were recorded and they were followed up for 45 (10) months.ResultsThe mean age of the patients (50% female) was 66 years, 64% had hypertension, 70% had dyslipidemia, and 26% had had a previous cardiovascular event. Cardiovascular disease, predominantly ischemic heart disease, was observed more frequently in men and a higher percentage had end-organ damage (57.7% of males vs 45.4% of females; P<.0001). Women had poorer glycemic control, higher total cholesterol levels, and lower high-density lipoprotein cholesterol levels. By the end of follow-up, 81 patients had died (5.7% of males vs 6.7% of females; P=.513). There were no sex differences in cardiovascular complications during follow-up (15.8% in males vs 13.7% in females; P=.368). Multivariate analysis identified the following factors as independent predictors of morbidity or mortality: age (hazard ratio [HR] = 1.04; 95% confidence interval [CI], 1.02-1.06), existing cardiovascular disease (HR=1.96; 95% CI, 1.38-2.79), diuretic treatment (HR=1.62; 95% CI, 1.10-2.38), and albuminuria (HR=1.86; 95% CI, 1.33-2.61).ConclusionsNo difference was observed in mediumterm prognosis, with regard to mortality and cardiovascular morbidity, between male and female diabetics from the same geographical area, despite the presence of clinical differences between the sexes.

Introducción y objetivosEvaluar la influencia del sexo en las complicaciones cardiovasculares en pacientes diabéticos.MétodosEstudio multicéntrico de cohortes prospectivas, en el que participaron 31 médicos de atención primaria, que registra las características de 1.423 pacientes diabéticos que acudieron de forma consecutiva a sus consultas y fueron seguidos durante 45 ± 10 meses.ResultadosPacientes (el 50% mujeres) con media de edad de 66 años, el 64% hipertensos, el 70% dislipémicos y el el 26% con eventos cardiovasculares previos. Se observa una mayor presencia de enfermedad cardiovascular, predominantemente cardiopatía isquémica, y un mayor porcentaje de lesión de órganos diana en los varones (el 57,7% de los varones y el 45,4% de las mujeres; p < 0,0001). Las mujeres presentan un peor control glucémico, cifras más elevadas de colesterol total y valores de lipoproteínas de alta densidad más bajos. Tras el periodo de seguimiento, fallecieron 81 pacientes (el 5,7 frente al 6,7%; p = 0,513). No hubo diferencias por sexo en cuanto a las complicaciones cardiovasculares durante el seguimiento (el 15,8 frente al 13,7%; p = 0,368). En el análisis multivariable, resultaron determinantes independientes de morbimortalidad: la edad (hazard ratio [HR] = 1,04; intervalo de confianza [IC] del 95%, 1,02-1,06), tener enfermedad cardiovascular (HR = 1,96; IC del 95%, 1,38-2,79), seguir tratamiento con diuréticos (HR = 1,62; IC del 95%, 1,10-2,38) y sufrir albuminuria (HR = 1,86; IC del 95%, 1,33-2,61).ConclusionesNo se observan diferencias en el pronóstico a medio plazo en cuanto a mortalidad y morbilidad cardiovascular entre mujeres y varones diabéticos de una única área geográfica, a pesar de diferencias clínicas.