Women with diabetes have a 44% greater chance of developing coronary heart disease than do men with diabetes, a large review and meta-analysis has shown.
In a retrospective review of data from more than 850,000 people that included over 28,000 confirmed coronary heart disease (CHD) events across the globe between 1966 and 2011, women with diabetes had nearly three times the likelihood (relative risk, 2.82) of developing CHD than did women without diabetes. Meanwhile, men with diabetes were only twice as likely (RR, 2.16) to have CHD than men without the disease. After adjustment for sex differences in other CHD factors such as tobacco use, women with diabetes had a 44% increased risk of developing heart disease, compared with men with the disease (RR, 1.44).
Sex differences in diabetes-related risk for CHD remained consistent across subgroups defined by age and region, and were unchanged when factoring nonfatal CHD events.
The study, conducted by researchers from Europe and Australia, appears online in Diabetologia 2014 [doi:10.1007/s00125-014-3260-6]. The findings corroborate a previous meta-analysis that also showed clinically meaningful sex differences lead to a greater CHD risk in women with diabetes than in men with diabetes (BMJ 2006;332:73-8 [doi:10.1136/bmj.38678.389583.7C]. Dr. Rachel Huxley of the University of Queensland School of Population Health in Australia, was an investigator in both studies.
Reasons for the disparity cannot be attributed to pharmacotherapy alone, according to the authors of the current study. Data reviewed in the study showed that women with diabetes were undertreated for cardiovascular disease risk factors prior to 1986, but that despite current increased awareness of the cardiovascular risks posed to women with diabetes, they are still less likely to achieve treatment targets.
“We hypothesize that the excess risk in women is due to a combination of both a greater deterioration in cardiovascular risk factor levels and a chronically elevated cardiovascular risk profile in the prediabetic state, driven by greater levels of adiposity in women, compared with men,” the authors wrote.
The authors cited previous research indicating that men develop diabetes at a lower body mass index (BMI), compared with women. As an example, in the UK General Practice Research Database, the BMI of those diagnosed with diabetes was on average 1.8 kg/m2 higher in women than in men. (Diabetologia 2012;55:1556-7).
“Greater awareness of early symptoms of CHD in women and sex-specific therapeutic risk factor management, irrespective of the presence of diabetes, is optimal for improving clinical outcomes in both women and men,” the authors concluded.
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