Higher risk of adverse cardiovascular outcomes in females with type 2 diabetes Mellitus: an Umbrella review of systematic reviews

Abstract

Background Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have excess mortality risk compared to their male counterparts. An important next step to address the high global burden of T2DM and cardiovascular disease (CVD) is an umbrella review to summarize data on sex differences in cardiovascular outcomes for patients with T2DM and assess the strength of the evidence observed. Methods Medline and Embase were searched from inception till 7th August 2022 for systematic reviews and meta-analyses studying the effects of sex on cardiovascular outcomes in T2DM patients. Results from reviews were synthesized with a narrative synthesis, with tabular presentation of findings and forest plots for reviews that performed a meta-analysis. Results 27 review articles evaluating sex differences in cardiovascular outcomes were included. Females with T2DM had higher risk of developing coronary heart disease (CHD; RRR: 1.52, 95%CI: 1.32–1.76, p < 0.001), acute coronary syndrome (ACS; RRR: 1.38, 95%CI: 1.25–1.52, p < 0.001), heart failure (RRR: 1.09, 95%CI: 1.05–1.13, p < 0.001) than males. Females had a higher risk of all-cause mortality (RRR: 1.13, 95%CI: 1.07–1.19, p < 0.001), cardiac mortality (RRR: 1.49, 95%CI: 1.11–2.00, p = 0.009) and CHD mortality (RRR: 1.44, 95%CI: 1.20–1.73, p < 0.001) as compared to males. Conclusions This umbrella review demonstrates that females with T2DM have a higher risk of cardiovascular outcomes than male counterparts. Future research should address the basis of this heterogeneity and epidemiological factors for better quality of evidence, and identify actionable interventions that will narrow these sex disparities.

Elevated FIB-4 Is Associated with Higher Rates of Cardiovascular Disease and Extrahepatic Cancer History in Patients with Type 2 Diabetes Mellitus

“…It has been speculated that women can accumulate more fat and experience a more significant insulin resistance, remaining in a prediabetic state for a more extended period compared to males before the development of T2DM. This prolonged stay in a prediabetic state may be responsible for the higher risk of CVD in female T2DM patients compared to males [29]. It should be noted that even though our study revealed that females with T2DM had a greater likelihood of having a history of CVD, the number of male participants who had a history of CVD was higher than that of females.…”

“…Chadalavada et al, in a study of 22.685 diabetic patients from the UK Biobank study population, and Yoshida et al, in a cohort that was followed for up to 18.6 years, showed that female T2DM patients are at higher risk for CVD compared to males [27,28]. Moreover, a recent metaanalysis by Yaow et al confirmed these findings by showing that females with T2DM have a higher risk than males of developing coronary heart disease (RR: 1.52, 95%CI: 1.32-1.76, p < 0.001), acute coronary syndrome (RR: 1.38, 95%CI: 1.25-1.52, p < 0.001), and heart failure (RR: 1.09, 95%CI: 1.05-1.13, p < 0.001) [29]. It has been speculated that women can accumulate more fat and experience a more significant insulin resistance, remaining in a prediabetic state for a more extended period compared to males before the development of T2DM.…”

The burden of cardiovascular disease in Asia from 2025 to 2050: a forecast analysis for East Asia, South Asia, South-East Asia, Central Asia, and high-income Asia Pacific regions

“…21 Previous studies have shown that countries in the region such as Kyrgyzstan and Uzbekistan have struggled with the underdiagnosis and undertreatment of diabetes, attributed to insufficient clinical training, diagnostic tools, and patient involvement. 21 Given the substantial CV risk conferred by diabetes, 3 , 4 , 5 , 22 there is a particular need in Central Asia to bolster healthcare infrastructures and target optimal glycaemic control so as to alleviate the impending CV crisis. 21 The outlook for a healthy future in diabetes remediation will need sustainable progress in early diagnosis, patient education, regular healthcare screening, and ensuring equitable medication coverage, often requiring close oversight and scalability at a population level.…”

Nursing Students’ Motivation, Awareness, and Knowledge of Women’s Health: A Norwegian Quasi-Experimental Study

“…Several studies have reported sex and gender differences in the management and outcomes of acute myocardial infarction (ACS) [22][23][24][25][26][27][28][29][30], where women experience delays in time before treatment (i.e., door to balloon/symptom to balloon) [31][32][33][34], and are less likely to be treated invasively compared to men [25,26,30]. In recent decades, there has been a growing incidence of acute myocardial infarctions (AMIs) in young people, especially in women [35], where women with diabetes mellitus 2 (DM2) seem to have a higher risk of developing ACSs compared to men [36].…”