title: Risk factors, treatment and prognosis in men and women with heart failure with and without diabetes.
abstract: OBJECTIVE
  To test the hypothesis that risk factor pattern, treatment and prognosis differ between men and women with heart failure (HF) with and without diabetes in the Swedish Heart Failure Registry.
  
  
  METHODS
  Patients with (n=8809) and without (n=27 465) type 2 diabetes (T2DM) included in the Swedish Heart Failure Registry (2003-2011) were followed for mortality during a median follow-up of 1.9 years (range 0-8.7 years). All-cause mortality, differences in background and HF characteristics were analysed in women and men with and without T2DM and with a special regard to different age groups.
  
  
  RESULTS
  Of 36 274 patients, 24% had T2DM and 39% were women. In patients with T2DM, women were older than men (78 years vs 73 years), more frequently had hypertension, renal dysfunction and preserved ventricular function. Regardless of T2DM status, women with reduced ventricular function, compared with their male counterparts, were less frequently offered, for example, ACE inhibitors/angiotensin receptor II blockers (ARB). Absolute mortality was 48% in women with T2DM, 40% in women without; corresponding male mortality rates were 43% and 35%, respectively. Kaplan-Meier curves revealed shorter longevity in women with T2DM but female sex did not remain a significant mortality predictor following adjustment (OR 95% CI 0.90; 0.79 to 1.03). In those without T2DM, women compared with men lived longer; this pattern remained after adjustment (OR 0.72; 0.66 to 0.78). T2DM was a stronger predictor of mortality in women (OR 1.72; 1.53 to 1.94) than in men (OR 1.47; 1.34 to 1.61).
  
  
  CONCLUSIONS
  T2DM is a strong mortality predictor in men and women with HF, somewhat stronger in women. The shorter survival time in women with T2DM and HF related to comorbidities rather than sex per se. Evidence-based management was less prevalent in women. Mechanisms behind these findings remain incompletely understood and need further attention.
authors.affiliation: Cardiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Johansson
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Dahlström
authors.affiliation: Cardiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm.
authors.forename: Magnus
authors.initials: M
authors.lastname: Edner
authors.affiliation: Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Näsman
authors.affiliation: Cardiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm.
authors.forename: Lars
authors.initials: L
authors.lastname: Rydén
authors.affiliation: Cardiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm.
authors.forename: Anna
authors.initials: A
authors.lastname: Norhammar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome