Preoperative triglycerides predict post-coronary artery bypass graft survival in diabetic patients: a sex analysis.

Sprecher, Dennis L.; Pearce, Gregory L.; Park, Elizabeth M.; Pashkow, Fredric J.; Hoogwerf, Byron J.

doi:10.2337/diacare.23.11.1648

Cited by 19 publications

(9 citation statements)

References 21 publications

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“…It is plausible that increased serum triglycerides convey a higher mortality in diabetic women than in men, since increased triglycerides predict cardiovascular disease more consistently in women (40,41). One possible explanation is that women with type 2 diabetes respond differently to increased levels of serum triglycerides than do diabetic men.…”

Section: Survival In Type 2 Diabetesmentioning

confidence: 77%

Survival in Patients With Type 2 Diabetes in a Swedish Community

et al. 2002

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OBJECTIVE—To explore risk factors for all-cause mortality in patients with type 2 diabetes treated in primary care. RESEARCH DESIGN AND METHODS—A prospective population-based study of 400 patients with type 2 diabetes who consecutively completed an annual checkup in primary care in Skara, Sweden, during 1992–1993. Vital status was ascertained to year 2000. Baseline characteristics as predictors for mortality were analyzed by Cox regression and expressed as relative risks (RRs), with 95% CIs. RESULTS—During a mean follow-up time of 5.9 years, 131 patients died (56 deaths per 1,000 patients per year). In both sexes, all-cause mortality was predicted by HbA1c (by 1%; RR 1.14, 95% CI 1.01–1.27), and by LDL-to-HDL cholesterol ratios (1.15, 1.00–1.32). Increased mortality was also seen with prevalent hypertension (1.72, 1.21–2.44), microalbuminuria (1.87, 1.27–2.76), and previous cardiovascular disease (1.70, 1.15–2.50). Subanalyses revealed that increased mortality related to HbA1c was restricted to hypertensive patients with type 2 diabetes (1.23, 1.04–1.47). Serum triglycerides (by 1 mmol/l) predicted all-cause mortality in women (1.25, 1.06–1.47). CONCLUSIONS—Poor glucose and lipid control and hypertension predicted all-cause mortality. Survival was also predicted by prevalent microalbuminuria and by previous cardiovascular disease. Confirming results from clinical trials, this population-based study has implications for primary and secondary prevention.

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Section: Survival In Type 2 Diabetesmentioning

confidence: 77%

Survival in Patients With Type 2 Diabetes in a Swedish Community

et al. 2002

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“…[6][7][8]10 However, are similar risks demonstrated in the acute perioperative setting? Yes, results of this study indicate that half of the CABG patients at our institution have metabolic syndrome, and these patients experience adverse clinical outcomes such as longer postoperative stays www.ajcconline.org Table 2 Demographics by patient's sex and metabolic syndrome characterization infection, decreased tissue and organ perfusion, and compromised wound healing have all been associated with uncontrolled blood sugar levels in hospitalized patients who have undergone surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of individual risk factors that make up this syndrome, such as diabetes and hypertriglycerid emia, increases morbidity and mortality in postoperative CABG patients. 6,7 When these risk factors are examined as a cluster, the presence of metabolic syndrome in CABG patients is predictive of higher rates of occluded vein grafts within 5 years. 8 Metabolic syndrome is also an independent risk factor for atrial fibrillation after CABG surgery.…”

mentioning

confidence: 99%

Perioperative Outcomes of Coronary Artery Bypass Grafting: Effects of Metabolic Syndrome and Patient’s Sex

Brackbill

Sytsma

Sykes

2009

American Journal of Critical Care

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Background Perioperative outcome data related to metabolic syndrome in coronary artery bypass graft (CABG) patients are lacking. Objective To determine the incidence of metabolic syndrome in CABG patients and whether its presence or the patient’s sex affects postoperative lengths of stay in the intensive care unit and hospital. Methods A retrospective observational study in CABG patients. Risk factors from the Society of Thoracic Surgeons’ Adult Cardiac Surgery Database were used to categorize patients as having metabolic syndrome. Perioperative outcomes were compared between patients with and without metabolic syndrome and between sexes. Outcomes were based on the operational definitions of the Society of Thoracic Surgeons. Results Among 657 patients, 333 had metabolic syndrome; 63.8% (n = 215) of women and 36.9% (n = 118) of men (P ≤ .001). Mean postoperative stays were significantly longer in patients who had metabolic syndrome. Women had longer postoperative stays than did men. Mean postoperative stay for women was 2.7 (SD, 3.4) days in the intensive care unit and 8.2 (SD, 7.1) days in the hospital, compared with 2.0 (SD, 3.8) days in the intensive care unit (P = .01) and 6.6 (SD, 6.8) days in the hospital for men (P = .003). Women with metabolic syndrome also had higher rates of in-hospital death (P = .03). Conclusion Both female patients and patients with metabolic syndrome undergoing CABG surgery are at higher risk for longer postoperative stays. Women with metabolic syndrome are the CABG patients at highest risk for in-hospital death.

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“…In regard to the greater mortality of women with hypertriglyceridemia, no study in the literature was found relating the elevation in triglycerides to worse results in the in-hospital phase of myocardial revascularization surgery; only references to its later influence were found 44 . The greater mortality in the female sex in the remaining subgroups analyzed did not reach statistical significance, which prevents us from stating that no difference really exists or whether the sample did not reach a sufficient size for demonstrating the difference.…”

Section: Discussionmentioning

confidence: 99%

Resultados imediatos da cirurgia de revascularização miocárdica: comparação entre homens e mulheres

Amato¹,

Timerman²,

Paes³

et al. 2004

Arq. Bras. Cardiol.

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Several studies [1][2][3][4][5][6][7][8][9][10][11] have shown that women who undergo myocardial revascularization surgery (MR) have a greater in-hospital mortality rate and a greater rate of complications, as compared with those of men, the first of those studies being attributed to Bolooki et al 12 .Several studies 1,10,13 have reported a similar survival after surgery for men and women, while others 7,14,15 have reported a shorter survival for women, whose rates of angina recurrence are greater 16 and whose graft patency is lower 1,17 . On average, the surgical mortality rate for women has been reported as twice that of men. The reasons for that have not been completely clarified, and several hypotheses have been discussed. Studies 11 have shown that, on the occasion of surgery, women compared with men are usually older and have a greater number of risk factors and also of symptoms. Some of those factors, as well as the more unstable symptomatology, are known to relate to greater surgical morbidity and mortality rates 18 . The greater technical difficulty during surgery, with greater rates of complications and in-hospital mortality, has been attributed to the smaller body surface area, and, consequently, lower coronary diameter in the female sex, the anatomical aspects being the major thing responsible for the worse results in women 1,6,19,20 . Studies on autopsy 21 , angiography 22 , and in vivo with intracoronary ultrasound 23 have confirmed that women have coronary arteries of lower caliber than men do.Women have also been shown to receive fewer arterial grafts, mainly internal thoracic artery grafts 11 , which have been related in the literature to a lower mortality rate and fewer complications, even in the in-hospital phase 24 , in addition to their already known benefit in long-term evolution 25 . The reasons why the female sex has been less favored by these grafts have not been completely clarified.In some studies, after correction for age and risk factors, female sex has no longer been a prognosis for greater in-hospital mortality, indicating that those factors, and not sex per se, account for the greater surgical risk 5 . The same occurs with the analyses with the same correction, which consider, in addition to clinical factors, body surface and coronary diameter, showing that, in reality, "smaller" people, both men and women, have greater mortality and complication rates 1,6,10,19,20 . Those conclusions, however, have not been uniform, and, in some reports, even after correcting for these clinical and anatomical factors, the female sex has remained related to greater mortality (OR = 1.82; 95% CI = 1.07 to 3.11; P = 0.028) and urgent/emergency surgery (OR = 2.85; 95% CI = 1.32 to 6.14; P = 0.008). ConclusionThe female sex had a greater surgical mortality; this, however, was not an independent prognostic factor for death. The use of thoracic artery grafts proved to be protective. Older patients with renal failure in an emergency situation had greater indices of in-hospital death. Keywords myocardia...

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Preoperative triglycerides predict post-coronary artery bypass graft survival in diabetic patients: a sex analysis.

Cited by 19 publications

References 21 publications

Survival in Patients With Type 2 Diabetes in a Swedish Community

Survival in Patients With Type 2 Diabetes in a Swedish Community

Perioperative Outcomes of Coronary Artery Bypass Grafting: Effects of Metabolic Syndrome and Patient’s Sex

Resultados imediatos da cirurgia de revascularização miocárdica: comparação entre homens e mulheres

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