Sex differences in management and outcomes of patients with type 2 diabetes and cardiovascular disease: A report from TECOS

On behalf of the TECOS Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Aim: To examine sex differences in baseline characteristics and outcomes in patients with type 2 diabetes and atherosclerotic vascular disease. Materials and methods: Cox models were used to analyse the association between sex and outcomes in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), a randomized, placebo-controlled trial assessing the impact of sitagliptin on cardiovascular (CV) outcomes in patients with type 2 diabetes and atherosclerotic vascular disease. Results: A total of 4297 women and 10 374 men were followed for a median of 3.0 years. Women were slightly older and more often had cerebrovascular disease and peripheral arterial disease but less often coronary heart disease than men. At baseline, women were less likely to use aspirin or statins. The primary composite outcome of CV death, myocardial infarction, stroke, or hospitalization for unstable angina occurred in 418 women (9.7%) and 1272 men (12.3%; 3.48 vs 4.38 events/100 participant-years, crude hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.71-0.89, adjusted HR 0.64, 95% CI 0.55-0.74; P <.0001). Women also had a significantly lower risk of secondary CV outcomes and all-cause death. Conclusions: In this large prospective study of people with type 2 diabetes and CV disease, women had different CV disease burden, worse CV risk factor profiles, and less use of indicated medications than men. Despite this, women had significantly lower risk of CV events, suggesting that the cardioprotective effects of female sex extend to populations with type 2 diabetes.

Original languageEnglish (US)
Pages (from-to)2379-2388
Number of pages10
JournalDiabetes, Obesity and Metabolism
Volume20
Issue number10
DOIs
StatePublished - Oct 1 2018

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Sex Characteristics
Type 2 Diabetes Mellitus
Cardiovascular Diseases
Vascular Diseases
Confidence Intervals
Cerebrovascular Disorders
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Peripheral Arterial Disease
Unstable Angina
Sitagliptin Phosphate
Proportional Hazards Models
Aspirin
Coronary Disease
Cause of Death
Hospitalization
Randomized Controlled Trials
Stroke
Myocardial Infarction
Placebos
Prospective Studies

Keywords

  • cardiovascular
  • diabetes
  • sex difference
  • sitagliptin

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Sex differences in management and outcomes of patients with type 2 diabetes and cardiovascular disease : A report from TECOS. / On behalf of the TECOS Study Group.

In: Diabetes, Obesity and Metabolism, Vol. 20, No. 10, 01.10.2018, p. 2379-2388.

Research output: Contribution to journalArticle

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title = "Sex differences in management and outcomes of patients with type 2 diabetes and cardiovascular disease: A report from TECOS",
abstract = "Aim: To examine sex differences in baseline characteristics and outcomes in patients with type 2 diabetes and atherosclerotic vascular disease. Materials and methods: Cox models were used to analyse the association between sex and outcomes in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), a randomized, placebo-controlled trial assessing the impact of sitagliptin on cardiovascular (CV) outcomes in patients with type 2 diabetes and atherosclerotic vascular disease. Results: A total of 4297 women and 10 374 men were followed for a median of 3.0 years. Women were slightly older and more often had cerebrovascular disease and peripheral arterial disease but less often coronary heart disease than men. At baseline, women were less likely to use aspirin or statins. The primary composite outcome of CV death, myocardial infarction, stroke, or hospitalization for unstable angina occurred in 418 women (9.7{\%}) and 1272 men (12.3{\%}; 3.48 vs 4.38 events/100 participant-years, crude hazard ratio [HR] 0.79, 95{\%} confidence interval [CI] 0.71-0.89, adjusted HR 0.64, 95{\%} CI 0.55-0.74; P <.0001). Women also had a significantly lower risk of secondary CV outcomes and all-cause death. Conclusions: In this large prospective study of people with type 2 diabetes and CV disease, women had different CV disease burden, worse CV risk factor profiles, and less use of indicated medications than men. Despite this, women had significantly lower risk of CV events, suggesting that the cardioprotective effects of female sex extend to populations with type 2 diabetes.",
keywords = "cardiovascular, diabetes, sex difference, sitagliptin",
author = "{On behalf of the TECOS Study Group} and Joakim Alfredsson and Green, {Jennifer B.} and Stevens, {Susanna R.} and Reed, {Shelby D.} and Armstrong, {Paul W.} and {Angelyn Bethel}, M. and Engel, {Samuel S.} and McGuire, {Darren K} and {Van de Werf}, Frans and Irene Hramiak and White, {Harvey D.} and Peterson, {Eric D.} and Holman, {Rury R.}",
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T1 - Sex differences in management and outcomes of patients with type 2 diabetes and cardiovascular disease

T2 - A report from TECOS

AU - On behalf of the TECOS Study Group

AU - Alfredsson, Joakim

AU - Green, Jennifer B.

AU - Stevens, Susanna R.

AU - Reed, Shelby D.

AU - Armstrong, Paul W.

AU - Angelyn Bethel, M.

AU - Engel, Samuel S.

AU - McGuire, Darren K

AU - Van de Werf, Frans

AU - Hramiak, Irene

AU - White, Harvey D.

AU - Peterson, Eric D.

AU - Holman, Rury R.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Aim: To examine sex differences in baseline characteristics and outcomes in patients with type 2 diabetes and atherosclerotic vascular disease. Materials and methods: Cox models were used to analyse the association between sex and outcomes in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), a randomized, placebo-controlled trial assessing the impact of sitagliptin on cardiovascular (CV) outcomes in patients with type 2 diabetes and atherosclerotic vascular disease. Results: A total of 4297 women and 10 374 men were followed for a median of 3.0 years. Women were slightly older and more often had cerebrovascular disease and peripheral arterial disease but less often coronary heart disease than men. At baseline, women were less likely to use aspirin or statins. The primary composite outcome of CV death, myocardial infarction, stroke, or hospitalization for unstable angina occurred in 418 women (9.7%) and 1272 men (12.3%; 3.48 vs 4.38 events/100 participant-years, crude hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.71-0.89, adjusted HR 0.64, 95% CI 0.55-0.74; P <.0001). Women also had a significantly lower risk of secondary CV outcomes and all-cause death. Conclusions: In this large prospective study of people with type 2 diabetes and CV disease, women had different CV disease burden, worse CV risk factor profiles, and less use of indicated medications than men. Despite this, women had significantly lower risk of CV events, suggesting that the cardioprotective effects of female sex extend to populations with type 2 diabetes.

AB - Aim: To examine sex differences in baseline characteristics and outcomes in patients with type 2 diabetes and atherosclerotic vascular disease. Materials and methods: Cox models were used to analyse the association between sex and outcomes in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), a randomized, placebo-controlled trial assessing the impact of sitagliptin on cardiovascular (CV) outcomes in patients with type 2 diabetes and atherosclerotic vascular disease. Results: A total of 4297 women and 10 374 men were followed for a median of 3.0 years. Women were slightly older and more often had cerebrovascular disease and peripheral arterial disease but less often coronary heart disease than men. At baseline, women were less likely to use aspirin or statins. The primary composite outcome of CV death, myocardial infarction, stroke, or hospitalization for unstable angina occurred in 418 women (9.7%) and 1272 men (12.3%; 3.48 vs 4.38 events/100 participant-years, crude hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.71-0.89, adjusted HR 0.64, 95% CI 0.55-0.74; P <.0001). Women also had a significantly lower risk of secondary CV outcomes and all-cause death. Conclusions: In this large prospective study of people with type 2 diabetes and CV disease, women had different CV disease burden, worse CV risk factor profiles, and less use of indicated medications than men. Despite this, women had significantly lower risk of CV events, suggesting that the cardioprotective effects of female sex extend to populations with type 2 diabetes.

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KW - diabetes

KW - sex difference

KW - sitagliptin

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