Sex and ethnic differences in the cardiovascular complications of type 2 diabetes

Abstract

Diabetes mellitus represents a global health concern affecting 463 million adults and is projected to rapidly rise to 700 million people by 2045. Amongst those with type 2 diabetes (T2D), there are recognised differences in the impact of the disease on different sex and ethnic groups. The relative risk of cardiovascular complications between individuals with and without T2D is higher in females than males. People of South Asian heritage are two to four times more likely to develop T2D than white people, but conversely not more likely to experience cardiovascular complications. Differences in the pathophysiological responses in these groups may identify potential areas for intervention beyond glycaemic control. In this review, we highlight key differences of diabetes-associated cardiovascular complications by sex and ethnic background, with a particular emphasis on South Asians. Evidence assessing therapeutic efficacy of new glucose lowering drugs in minority groups is limited and many major cardiovascular outcomes trials do not report ethnic specific data. Conversely, lifestyle intervention and bariatric surgery appear to have similar benefits regardless of sex and ethnic groups. We encourage future studies with better representation of women and ethnic minorities that will provide valuable data to allow better risk stratification and tailored prevention and management strategies to improve cardiovascular outcomes in T2D.

Exploring the Complex Relationship between Diabetes and Cardiovascular Complications: Understanding Diabetic Cardiomyopathy and Promising Therapies

“…Studies have shown that there is a significant interaction between diabetes and obesity on the risk for concentric cardiomyocyte hypertrophy [ 31 , 32 , 33 ]. The Strong Heart Study conducted on Native Americans revealed that higher LV mass and wall thickness were evident in cases with diabetes, explaining the association between diabetes and LVH.…”

Does race/ethnicity influence the impact of new glucose-lowering agents on cardiovascular outcomes? a comparison between Asian versus White patients

“…Comparisons with White patients led to contrasting results. South Asian people are two to four times more likely to develop T2DM than White individuals, but conversely do not experience more CV complications ( 23 ). Nevertheless, South Asian people, who represent a large, growing population in many European countries, have been shown to be at higher risk of developing not only T2DM, but also other risk factors such as atherogenic dyslipidaemia, leading to higher prevalence of coronary heart disease and stroke than in other ethnic groups living in Europe ( 17 ).…”

Combined Effects of Obesity and Dyslipidaemia on the Prevalence of Diabetes Amongst Adults Aged ≥45 Years: Evidence from a Nationally Representative Cross-Sectional Study

“…Elderly people are at a high risk of diabetes [6]. By 2045, the prevalence of diabetes worldwide will rise to 10.9% (700 million people) [7]. In China, the prevalence of diabetes was 0.67% in 1980, and it increased to 10.9% and 11.2% in 2013 and 2015, respectively [8,9].…”