title: Sex differences in epidemiology and risk factors of acute coronary syndrome in Chinese patients with type 2 diabetes: a long-term prospective cohort study.
abstract: OBJECTIVE
  Diabetic patients with acute coronary syndrome (ACS) are at higher risk of poor outcome than are non-diabetic patients with ACS. Few studies have focused on sex-related ACS incidence, ACS-related mortality or risk factors to affects sex specific ACS in Chinese with Type 2 diabetes mellitus (T2DM). Based on a hospital-based cohort of Chinese patients with T2DM, we aimed to investigate whether there was sex difference in ACS or ACS-related mortality or risk factors of ACS.
  
  
  METHODS
  Totally 2,135 Hong Kong Chinese with T2DM were recruited during 1994-1996 and followed up until August 2012. We systematically analyzed sex-related ACS incidence and ACS-related mortality and risk factors with χ2-squared test, descriptive statistics and survival analysis.
  
  
  RESULTS
  Regular follow-up was completed in 2,105 subjects (98.6%), with a median period of 14.53 years. The occurrence of ACS was recorded among 414 patients (19.7%) and ACS-related death among 104 patients (4.9%). ACS incidences increased with age in both men and women, and men had a higher prevalence of ACS than women across different age categories and different follow-up periods (log rank χ2=20.32, P<0.001). The transition of ACS incidences from slow to rapid increase were about 5 years earlier in men (at 51-55 years) than in women (55-60 years). Among ACS patients, cumulative ACS-related mortalities was similar between men and women (log rank χ2=0.063, P=0.802). Besides age and albuminuria, different profiles of risk factors accounted for the occurrence of ACS between men and women.
  
  
  CONCLUSIONS
  Our findings demonstrated sex differences in ACS incidence and risk factors, but not in ACS-related mortality in Chinese patients withT2DM. These findings suggest that screening and prevention campaigns should be optimized for men and women, which may help to identify diabetic patients at higher risk of coronary heart disease.
authors.affiliation: Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Jian Gang
authors.initials: JG
authors.lastname: Duan
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Xiang Yan
authors.initials: XY
authors.lastname: Chen
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Alex
authors.initials: A
authors.lastname: Lau
authors.affiliation: Department of Psychological Studies and Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Hong Kong Special Administrative Region.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom.
authors.forename: G Neil
authors.initials: GN
authors.lastname: Thomas
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Brian
authors.initials: B
authors.lastname: Tomlinson
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Roxanna
authors.initials: R
authors.lastname: Liu
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Leung
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mok
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
authors.forename: Ka Sing
authors.initials: KS
authors.lastname: Wong
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D017678:Sex Distribution
references.citation: Heart. 2009 Jan;95(1):20-6
references.pmid: 18463200
references.citation: Circulation. 2004 Feb 10;109(5):565-7
references.pmid: 14769676
references.citation: Lancet. 2010 Jun 26;375(9733):2215-22
references.pmid: 20609967
references.citation: Clin Nephrol. 2001 Jan;55(1):7-15
references.pmid: 11200871
references.citation: N Engl J Med. 1999 Jun 10;340(23):1801-11
references.pmid: 10362825
references.citation: J Am Coll Cardiol. 2006 Feb 7;47(3 Suppl):S4-S20
references.pmid: 16458170
references.citation: Cerebrovasc Dis. 2003;16(3):217-23
references.pmid: 12865608
references.citation: Circulation. 2014 Jan 21;129(3):e28-e292
references.pmid: 24352519
references.citation: Glob Heart. 2014 Dec;9(4):381-90
references.pmid: 25592791
references.citation: N Engl J Med. 2010 Mar 25;362(12):1090-101
references.pmid: 20335585
references.citation: Zhonghua Xin Xue Guan Bing Za Zhi. 2011 Jan;39(1):3-22
references.pmid: 21418789
references.citation: Cardiovasc Res. 2005 May 1;66(2):295-306
references.pmid: 15820198
references.citation: World J Cardiol. 2012 Feb 26;4(2):36-47
references.pmid: 22379536
references.citation: JAMA. 2013 Sep 4;310(9):948-59
references.pmid: 24002281
references.citation: Diabetes Care. 2000 Jul;23(7):962-8
references.pmid: 10895847
references.citation: Diabetes Care. 1997 Jul;20(7):1183-97
references.pmid: 9203460
references.citation: Circulation. 2004 Sep 21;110(12):1572-8
references.pmid: 15364810
references.citation: Diab Vasc Dis Res. 2004 May;1(1):23-32
references.pmid: 16305052
references.citation: Stroke. 2000 Nov;31(11):2641-7
references.pmid: 11062288
references.citation: Ann Intern Med. 1997 Feb 15;126(4):296-306
references.pmid: 9036802
references.citation: J Am Coll Cardiol. 2006 Feb 7;47(3 Suppl):S66-71
references.pmid: 16458175
references.citation: Am J Epidemiol. 1996 Feb 15;143(4):338-50
references.pmid: 8633618
references.citation: Diab Vasc Dis Res. 2014 Nov;11(6):395-409
references.pmid: 25187508
references.citation: Gynecol Endocrinol. 2012 Sep;28(9):746-51
references.pmid: 22329808
references.citation: Int J Cardiol. 2015 Jan 20;179:546-51
references.pmid: 25466560
references.citation: Am Heart J. 2012 Jan;163(1):66-73
references.pmid: 22172438
references.citation: Lancet. 2006 Jul 1;368(9529):29-36
references.pmid: 16815377
references.citation: Arch Intern Med. 2002 Aug 12-26;162(15):1737-45
references.pmid: 12153377
references.citation: Am J Physiol Renal Physiol. 2001 Mar;280(3):F365-88
references.pmid: 11181399
references.citation: Am J Manag Care. 2001 Oct;7(10):951-6
references.pmid: 11669359
references.citation: Neth Heart J. 2010 Dec;18(12):598-602
references.pmid: 21301622
references.citation: BMJ Open. 2014;4(7):e005077
references.pmid: 24993762
references.citation: Rev Port Cardiol. 2015 Jan;34(1):43-50
references.pmid: 25578946