Women with type 2 diabetes and coronary artery disease have a higher risk of heart failure than men, with a significant gender interaction between heart failure risk and risk factor management: a retrospective registry study

Abstract

IntroductionWomen are generally perceived to have a lower risk of cardiovascular events than men, despite a lack of data, particularly among patients with diabetes. Here, we investigated gender differences in the risk of heart failure (HF) events in patients with type 2 diabetes and coronary artery disease (CAD). We also assessed the association between cardiovascular risk factor management and HF events.Research design and methodsThis retrospective registry study enrolled consecutive patients with both type 2 diabetes and CAD, based on angiography records and medical charts at 70 teaching hospitals in Japan, from January 2005 to December 2015.ResultsThe registry included 7785 patients with a mean follow-up period of 1328 days. The mean age of the patients was 67.6 years. The risk of hospitalization for HF in patients with both type 2 diabetes and CAD was significantly higher among women than among men (HR, 1.26, 95% CI 1.06 to 1.50). The relationship between HF risk and achieved low-density lipoprotein cholesterol (LDL-c) and systolic blood pressure, but not hemoglobin A1c, differed between women and men, with statistically significant interactions (p=0.009 and p=0.043, respectively).ConclusionsWomen with type 2 diabetes and CAD have a higher risk of HF than men. A significant gender interaction was observed in the association between HF risk and risk factor management, particularly regarding LDL-c and systolic blood pressure. The effectiveness of risk factor management may differ between men and women regarding HF prevention among patients with type 2 diabetes and CAD.

Sex differences in type 2 diabetes

“…Higher absolute risk of MACE-HF in men 12,142,998 men and women, T2D, 253,260 HF events, 90–95% Ohkuma et al (2019) [ 73 ] Diabetes duration: ≥16 years Systematic review 47 cohorts. Studies from Europe, Asia, Northern America, Australasia HF: higher risk in women vs men with type 2 diabetes, RRR 1.09 (1.05, 1.13) 7785 men and women, T2D, mean age 67.6±10.7 years Fujita et al (2022) [ 74 ] Median 8 years (IQR 2–16) Retrospective registry study follow-up 1328 days, Japan Hospitalisation for HF: higher risk in women vs men with type 2 diabetes and CAD, HR 1.26 (1.06, 1.50) Microvascular Nephropathy 3410 patients; 49% women, 29% T2D, age 40–75 years de Ritter et al (2021) [ 79 ] Mean diabetes duration: 4–5 years The Maastricht Study, population-based, observational cohort study, the Netherlands Sensory nephropathy: higher risk in men with type 2 diabetes vs men with NGT, OR 2.46 (1.67, 3.63). Nephropathy: higher risk in men with type 2 diabetes vs men with NGT, OR 1.58 (1.01, 2.46).…”

“…Among patients with type 2 diabetes, women also have a greater RR of heart failure and hospitalisation due to heart failure than men [ 73 , 74 ]. This was also evidenced at a younger age, although the women-to-men ratio fell with increasing age [ 68 ].…”

Geschlechtsspezifische Aspekte bei Prädiabetes und Diabetes mellitus – klinische Empfehlungen (Update 2023)

“…Im direkten Vergleich zu Männern haben aber Frauen mit T1DM oder T2DM das höhere relative Risiko (T1DM 47 %, T2DM 9 %). Auch das Risiko für eine Hospitalisierung wegen Herzinsuffizienz ist bei Frauen mit T2DM höher [ 45 , 63 ]. In einer niederländischen Observationsstudie wurde eine 25 % höhere Inzidenzrate für den primären Endpunkt (Mortalität oder Hospitalisierung wegen Herzinsuffizienz) bei Männern mit bekannter chronischer Herzinsuffizienz beobachtet.…”