Sex, Clinical Symptoms, and Angiographic Findings in Patients With Diabetes Mellitus and Coronary Artery Disease (from the Bypass Angioplasty Revascularization Investigation [BARI] 2 Diabetes Trial)

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• 作者：Jacqueline E. Tamis-Holland MD^a ; ^{jtamis@chpnet.org} ; Jiang Lu MS^b ; Vera Bittner MD^c ; Michelle F. Magee MD^d ; Neuza Lopes MD^e ; Dale S. Adler MD^f ; Kevin E. Kip PhD^g ; Leonard Schwartz MD^h ; Yolanda A. Groenewoud MD^h ; Alice K. Jacobs MDⁱ ; BARI 2D Study Group
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：1 April 2011
• 年：2011
• 卷：107
• 期：7
• 页码：980-985
• 全文大小：187 K

文摘

Previous studies have reported differences in presenting symptoms and angiographic characteristics between women and men undergoing evaluation for suspected coronary artery disease (CAD). We examined the relation between symptoms and extent of CAD in patients with type 2 diabetes mellitus and known CAD enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Of 1,775 patients (533 women, 30 % , and 1,242 men, 70 % ), women were more likely than men to have angina (65 % vs 56 % , p <0.001) or an atypical angina/anginal equivalent (71 % vs 58 % , p <0.001). More women reported unstable angina (17 % vs 13 % , p = 0.047) or were in a higher Canadian Cardiology Society class compared to men (Canadian Cardiology Society classes II to IV 78 % vs 68 % , p = 0.002). Fewer women than men had no symptoms (14 % vs 22 % , p <0.001). Women had a lower mean myocardial jeopardy index (42.5 ± 24.3 vs 47.9 ± 24.3, p <0.001), smaller number of total significant lesions (2.3 ± 1.7 vs 2.7 ± 1.8, p <0.001), and fewer jeopardized left ventricular regions (p <0.001 for distribution) or long-term occlusions (29 % vs 42 % , p <0.001). After adjustment for relevant covariates, the odds of having CAD symptoms were still higher in women than men (odds ratio for angina 1.31, 95 % confidence interval 1.02 to 1.69; odds ratio for atypical angina 1.52, 95 % confidence interval 1.17 to 1.96). In conclusion, in a high-risk group of patients with known CAD and diabetes mellitus, women were more symptomatic than men but had less obstructive CAD. These data suggest that factors other than epicardial CAD severity influence symptom presentation in women in this population.