Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies.

Abstract

A meta-analysis of prospective studies O R I G I N A L A R T I C L EOBJECTIVE -Women are at a much lower risk of coronary disease mortality than men are. It is widely believed that diabetes "erases" this female advantage, increasing the risk of heart disease much more in women than in men. In reality, the extent of this increased risk is controversial, with studies showing conflicting results and wide confidence intervals. Clarification of this issue has implications for the pathogenesis of coronary disease, and for public health efforts to reduce coronary disease in women.RESEARCH DESIGN AND METHODS -We performed a meta-analysis to calculate a summary estimate of the relative risk of coronary death among women with diabetes as compared to those without. For comparison, we also calculated the analogous risk among men. All prospective cohort studies containing both men and women, and both patients with and without diabetes, were examined. Sixteen studies were identified; 10 had sufficient data for statistical analysis.RESULTS -After combining studies that adjusted for other cardiac risk factors, the relative risk of coronary death from diabetes was 2.58 (95% CI 2.05-3.26) for women and 1.85 (1.47-2.33) for men. This difference is statistically significant (P = 0.045). Other sensitivity analyses did not change these estimates appreciably.CONCLUSIONS -The impact of diabetes on the risk of coronary death is significantly greater for women than men. Further research is required to explain this clinically meaningful difference between the sexes. Diabetes Care 23:962-968, 2000

Coronary Risk Estimation according to the Framingham-Wilson Score and Impaired Fasting Glucose in Adult Subjects from Maracaibo city, Venezuela

“…Future prospective studies are needed to evaluate which metabolic control surrogate (and corresponding cut-off point) should be used according to pharmacological treatment, evolution of prediabetes/ diabetes, weight control, physical activity, nutritional variables and comorbidities observed in the patients. Assessment of coronary risk by gender in each glycemic status group revealed that IFG men have a significantly higher risk than their female counterparts, similar to previous results from Modrego et al [47]; however, it should be noted that coronary risk remained similar between genders among diabetics, demonstrating the role of T2DM as a gender-independent cardiovascular risk factor [48]. Although the presence of IFG has been associated with increased cardiovascular risk through its association with comorbities such as dyslipidemia and hypertension [49], several studies have proposed possible mechanisms which chronic IFG may trigger endothelial dysfunction, or at least, play a role in atherogenesis by increasing production of reactive oxygen species [50], advanced glycation endproducts [51], and inducing low-grade inflammation [52].…”

Gender-specific risk factors for mortality associated with incident coronary heart disease—A prospective community-based study

“…Our results show indeed a differential effect of diabetes mellitus, which was a significant risk factor for longer term mortality among females with AMI but not among males with AMI. This gender-specific effect has been described earlier (Crowley et al, 2003;Lee et al, 2000), and suggested explanations include HDL cholesterol, estrogens, coagulation, patterns of obesity, or hyperinsulinemia (Lee et al, 2000) and lower use of effective cardiac medications in female than male diabetics (Crowley et al, 2003). The discussion of these theories and others is beyond the scope of this article; suffice to say that the underlying basis for the gender differences in risk from diabetes remains, for the most part, speculative.…”

“…Second, risk factors may have differential effects for males and females. A meta-analysis showed that the impact of diabetes on CHD mortality is greater for females (Lee et al, 2000), while males show greater effects of disability, cholesterol and smoking (Janghorbani et al, 1993;Kattainen et al, 2004;Marang-van de Mheen et al, 2001).…”

Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly-diagnosed diabetes

“…Several studies indicated a greater relative risk of CVD with diabetes [4,14] and hyperglycaemia [7,11,15] among women than men, while the Hoorn Study reported no consistent differences [9]. Two previous meta-analyses, which included studies that did not adjust for major CVD risk factors, concluded that diabetes is a stronger risk factor for CVD mortality in women than in men [16,17]. A recent meta-analysis indicated that the excess relative risk of CVD mortality in women compared with men who had diabetes was absent after adjusting for classic CVD risk factors [18].…”