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CV risk in women with type 1 diabetes nearly double that in men
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Women with type 1 diabetes have approximately 40% greater risk for death from all causes, and two times the risk for fatal and nonfatal vascular events, than men with the disease, according to research published in The Lancet, Diabetes & Endocrinology.
“Type 1 diabetes is a big risk factor for cardiovascular diseases, but for some reason, it is more deadly in women than in men with the condition,” Rachel Huxley, MA, DPhil, told Endocrine Today. “Women with type 1 diabetes have double the risk of dying from heart disease and stroke compared with men with the condition.”
Rachel Huxley
Huxley and colleagues from other institutions reviewed 26 studies from PubMed published between 1966 and Nov. 26, 2014. The studies reported sex-specific estimates of the standardized mortality ratio (SMR) or HRs related to type 1 diabetes for all-cause mortality or cause-specific outcomes. Data encompassed 214,114 individuals and 15,273 events.
The investigators used random-effects meta-analyses with inverse variance weighting to find sex-specific SMRs and their pooled ratio of women to men for events linked to type 1 diabetes, including all-cause mortality, mortality from CVD, renal disease, cancer and combined outcome of accident and suicide, and incident coronary heart disease and stroke.
The pooled women-to-men ratio of the SMR was 1.37 (95% CI, 1.21-1.56) for all-cause mortality, 1.37 (95% CI, 1.03-1.81) for incident stroke, 1.44 (95% CI, 1.02-2.05) for fatal renal disease and 1.86 (95% CI, 1.62-2.15) for fatal CVDs.
The difference between sexes was more extreme for incident CHD, with the pooled women-to-men ratio of the SMR at 2.54 (95% CI, 1.8-3.6). For cancer or accident and suicide, no evidence suggested a sex difference for mortality related to type 1 diabetes.
“Individuals diagnosed with type 1 diabetes need to have their CV risk factors, including blood glucose, blood pressure and lipids, monitored and treated more aggressively in order to lower the risk of having a heart attack or stroke,” Huxley said. “This is true for both women and men, although the benefits are likely to be greater for women if they were able to achieve better control of their risk factor levels.”
Studies focusing specifically on physiologic and behavioral differences between women and men with type 1 diabetes are needed moving forward, Huxley said.
“(This will help) shed light on what’s causing the greater risk of vascular disease in women with the condition compared with men,” she said.
In an accompanying commentary, David Simmons, MD, of the University of Western Sydney, Campbelltown, New South Wales, Australia, said reducing this excess risk in women is challenging, and additional investigation is needed.
David Simmons
“Women with type 1 diabetes lose more years of life than men with type 1 diabetes; for example, there is a partial loss of the ‘natural’ protection that women have from conditions such as coronary heart disease,” Simmons told Endocrine Today. “The mechanism for this partial loss is unknown, and more research is needed to identify why this is and ways to address and protect against it.”
Men with type 1 diabetes die younger than women with the condition because men die younger than women in general, Simmons noted.
“What we do know is that, right now, we can start to reduce premature death among both men and women with type 1 diabetes through better glucose control,” he said.
Health systems must improve access to methods to prevent glucose variability and hypoglycemia and help patients feel safer about having a more normal blood glucose levels, he said.
“This can be achieved through provision of better quality-assured structured diabetes education and support, better use of insulin delivery mechanisms, particularly insulin pumps for those that are not getting the best results from multiple injections, and better use of glucose monitoring approaches, including continuous glucose monitoring systems where individuals are likely to benefit,” Simmons said. – by Allegra Tiver
For more information:
Rachel Huxley, MA, DPhil, can be reached at Level 2, Public Health Building, School of Population Health, University of Queensland, Herston Road, Herston 4006, Queensland, Australia; email: r.huxley@uq.edu.au.
David Simmons, MD, can be reached at UWS School of Medicine, Locked Bag 1797 NSW 2751 Australia; email: da.simmons@uws.edu.au.
Disclosure: The researchers report no relevant financial disclosures.
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