Gender-age peculiarities of smoking and diabetes mellitus role in the development of myocardial infarction in patients with arterial hypertension
Authors: Aksenova Anna V. , Oshchepkova Elena V. , Orlovsky Aleksej A. , Chazova Irina E. 
Published: February 2021

Arterial hypertension (AH), smoking and type 2 diabetes mellitus (T2DM) are the risk factors for the development of myocardial infarction (MI). Their age and gender peculiarities of AH have been studied only in a small number of epidemiological studies.
Aim. To study the effect of smoking status and type 2 diabetes on the incidence of MI in men and women with hypertension.
Materials and methods. The frequency of MI in men and women with hypertension confirmed by ECG criteria was analyzed depending on age, smoking status and type 2 diabetes. 28 899 hypertensive patients of primary health care in 20102016 were included in the registry of hypertension.
Results. In the age of 2544 the number of visits of men and women with hypertension in primary health care was the same, thereafter the ratio of men progressively had been decreasing with the age. The incidence of MI in men with hypertension is significantly higher at all ages than in women (it is 18.3 times higher at the age of 2544). 37.4% of men and 94.8% of women with hypertension have never smoked. The maximum incidence of MI is in middle-aged men (33.0%) and in old-aged women (14.1%) groups, who stopped smoking. MI developed in 3.7 times more often in hypertensive young-age men group who are smoking than in nonsmokers, in those who stopped smoking 13 times more often. The maxima of the curves of the incidence of MI in women with hypertension, based on the smoking status, shifted towards an older age in comparison with men. Percutaneous coronary intervention / Coronary artery bypass graft surgery was performed 2 times more often in hypertensive patients with MI who stopped smoking, compared to nonsmokers. The incidence of MI in hypertensive patients with diabetes in middle-aged men increased by 1.6 times, in women 2.5 times. The higher influence of diabetes mellitus on escalation of MI incidence in women with hypertension than in men persisted until old age. The incidence of MI was 9.8% in never-smoked, 17.7% for smokers and 28.3% for stopped smoking hypertensive patients with diabetes. In the group of patients who never smoked, the risk of MI increased by 1.8 times in the men group and 2.8 in women with AH and DM. However, the odds of MI development in nonsmoking men and women groups with hypertension and diabetes did not significant.
Conclusion. Gender-age characteristics of the influence of smoking and type 2 diabetes on the risk of MI in patients with hypertension in primary health care were disclosed. Such risk factors for MI as male gender and smoking are most significant at a young age. In old age, smoking status no longer affects the risk of MI, while the male gender remains important at all ages. The higher incidence of MI in men with hypertension (18.3 times at a young age) compared to women is explained by both the influence of gender and the higher frequency of smoking (12 times). T2DM increases the risk of developing MI in middle age and older. In hypertensive patients with type 2 diabetes, the incidence of MI is maximally increased in middle age in women by 2.5 times; in men 1.6 times. Smoking in patients with AH and type 2 diabetes leads to an additional increase of MI risk (up to 2.8 times).