title: A propensity-matched study of the effect of diabetes on the natural history of heart failure: variations by sex and age.
abstract: BACKGROUND
  Poor prognosis in heart failure (HF) patients with diabetes is often attributed to increased co-morbidity and advanced disease. Further, this effect may be worse in women.
  
  
  OBJECTIVE
  To determine whether the effect of diabetes on outcomes and the sex-related variation persisted in a propensity score-matched HF population, and whether the sex-related variation was a function of age.
  
  
  METHODS
  Of the 7788 HF patients in the Digitalis Investigation Group trial, 2218 had a history of diabetes. Propensity score for diabetes was calculated for each patient using a non-parsimonious logistic regression model incorporating all measured baseline covariates, and was used to match 2056 (93%) diabetic patients with 2056 non-diabetic patients.
  
  
  RESULTS
  All-cause mortality occurred in 135 (25%) and 216 (39%) women without and with diabetes (adjusted HR = 1.67; 95% CI = 1.34 to 2.08; p<0.001). Among men, 535 (36%) and 609 (41%) patients without and with diabetes died from all causes (adjusted HR = 1.21; 95% CI = 1.07 to 1.36; p = 0.002). Sex-diabetes interaction (overall adjusted p<0.001) was only significant in patients > or = 65 years (15% absolute risk increase in women; multivariable p for interaction = 0.005), but not in younger patients (2% increase in women; p for interaction = 0.173). Risk-adjusted HR (95% CI) for all-cause hospitalisation for women and men were 1.49 (1.28 to 1.72) and 1.21 (1.11 to 1.32), respectively, also with significant sex-diabetes interaction (p = 0.011).
  
  
  CONCLUSIONS
  Diabetes-associated increases in morbidity and mortality in chronic HF were more pronounced in women, and theses sex-related differences in outcomes were primarily observed in elderly patients.
authors.affiliation: University of Alabama at Birmingham and VA Medical Center, Birmingham, AL 35294-2041, USA. aahmed@uab.edu
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.forename: Inmaculada B
authors.initials: IB
authors.lastname: Aban
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Jiannan
authors.initials: J
authors.lastname: Zhao
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.forename: Fernando
authors.initials: F
authors.lastname: Ovalle
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gambassi
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Dell'Italia
mesh_terms: D000367:Age Factors; D000407:Alabama / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000209:etiology* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors