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Female advantage in AMI mortality is reversed in patients with type 2 diabetes in the Skaraborg Project.

Two major risk factors for acute myocardial infarction (AMI) are hypertension and type 2 diabetes (1). Men are also recognized as having a higher incidence of AMI than women (1); however, in subjects with type 2 diabetes, the female advantage is known to disappear. In fact, a Finnish study recently presented a significant interaction between female sex and type 2 diabetes in the risk of coronary heart disease (CHD) (2). The current study was therefore designed to explore further the potential interaction between sex and type 2 diabetes in the risk of AMI in patients treated within primary care. Since previous studies in patients with type 2 diabetes have shown that hypertension has stronger macrovascular implications than type 2 diabetes itself, the analyses also include hypertension (3, 4).

In the Skaraborg county in southwestern Sweden, including the small community of Skara, patients with hypertension and/or diabetes have been treated at special outpatient clinics within primary care since the 1970s (the Skaraborg Hypertension and Diabetes Project) (5). From 1992 to 1993, all 1,149 patients with hypertension and/or diabetes who completed an annual check-up at the hypertension and diabetes clinic in Skara were consecutively surveyed for cardiovascular risk factors (5–10). From 1993 to 1994, a population survey using the same protocol as the patient survey was conducted with a randomized sample from the population census register, stratified by …