OBJECTIVE -To explain the stronger effect of type 2 diabetes on the risk of coronary heart disease (CHD) in women compared with men. RESEARCH DESIGN AND METHODS -The study population consisted of 1,296 nondiabetic subjects and 835 type 2 diabetic subjects aged 45-64 years without cardiovascular disease. The end points were CHD death and a major CHD event (CHD death or nonfatal myocardial infarction). The follow-up time was 13 years.RESULTS -Major CHD event rate per 1,000 person-years was 11.6 in nondiabetic men, 1.8 in nondiabetic women, 36.3 in diabetic men, and 31.6 in diabetic women. The diabetes-related hazard ratio for a major CHD event from the Cox model, adjusted for age and area of residence, was 2.9 (95% CI 2.2-3.9) in men and 14.4 (8.4 -24.5) in women, and after further adjustment for cardiovascular risk factors, 2.8 (2.0 -3.7) and 9.5 (5.5-16.9), respectively. The burden of conventional risk factors in the presence of diabetes was greater in women than in men at baseline. Prospectively, elevated blood pressure, low HDL cholesterol, and high triglycerides contributed to diabetes-related CHD risk more in women than in men. However, after adjusting for conventional risk factors, a substantial proportion of diabetes-related CHD risk remained unexplained in both genders.CONCLUSIONS -The stronger effect of type 2 diabetes on the risk of CHD in women compared with men was in part explained by a heavier risk factor burden and a greater effect of blood pressure and atherogenic dyslipidemia in diabetic women. Diabetes Care 27:2898 -2904, 2004T ype 2 diabetes increases the risk of coronary heart disease (CHD) more markedly in women than in men. However, the reported magnitudes of the diabetes-related CHD risk in men and women vary widely between different studies (1-5). The greater relative risk of CHD in diabetic women still remains incompletely understood, but several explanations can be offered. First, adverse changes induced by type 2 diabetes in some cardiovascular risk factors, such as HDL cholesterol, triglycerides, LDL particle size, and blood pressure, have been found to be more pronounced in women than in men (6 -8). Second, it is possible that gender may alter the effect of some cardiovascular risk factors for CHD in diabetic subjects, leading to a stronger risk effect in women. Third, diabetes in women may interfere more with protective mechanisms in the vascular wall and thereby lead to enhanced atherogenesis and/or thrombogenesis (9).In the present study, based on 13 years of follow-up of 1,296 nondiabetic and 835 type 2 diabetic subjects, we evaluated possible explanations for the stronger effect of type 2 diabetes on the risk of CHD in women than in men.RESEARCH DESIGN AND METHODS -Altogether, 1,059 subjects (581 men and 478 women) with type 2 diabetes aged 45-64 years and born and living in the Turku University Hospital district in West Finland and in the Kuopio University Hospital district in East Finland were identified through a national drug reimbursement register. A random sample of nondiab...
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