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Diabetes confers greater heart failure risk for women vs. men
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Both type 1 and type 2 diabetes are stronger risk factors for developing heart failure for women vs. men, suggesting a sex-specific approach is needed in diabetes research and clinical practice, according to an analysis of more than 12 million adults published in Diabetologia.
“It is important that women with and without diabetes, as well as health care providers, are aware of the , coronary heart disease, stroke and cancer following diabetes vs. men, and try to prevent the onset and manage the progression of diabetes,” Toshiaki Ohkuma, MD, PhD, an honorary senior fellow at the George Institute for Global Health at the University of New South Wales in Sydney, told Endocrine Today. “The excess risk of heart failure following a diagnosis of diabetes is high in both sexes, but significantly greater in women than men. Our findings highlight the importance of intensive prevention and treatment of diabetes for women as well as men.”
In a systematic review and meta-analysis, Ohkuma and colleagues analyzed data from 12,142,998 adults participating in 14 studies assessing sex-specific estimates of relative risk for heart failure associated with diabetes (253,260 heart failure events). Two studies included sex-stratified data on heart failure risk in type 1 diabetes (n = 3,284,123; heart failure events, 95,129), and 13 studies included data on heart failure among individuals with type 2 diabetes (n = 11,925,128; heart failure events, 249,560). Researchers used random-effects meta-analyses with inverse variance weighting to calculate pooled, sex-specific RRs and women-to-men ratio of RRs (RRRs) for heart failure associated with diabetes.
The pooled multiple-adjusted RR for heart failure associated with type 1 diabetes was 5.15 (95% CI, 3.43-7.74) among women and 3.47 (95% CI, 2.57-4.69) among men, for an RRR of 1.47 (95% CI, 1.44-1.9). Corresponding pooled RRs for heart failure associated with type 2 diabetes were 1.95 (95% CI, 1.7-2.22) among women and 1.74 (95% CI, 1.55-1.95) among men, for a pooled RRR of 1.09 (95% CI, 1.05-1.13).
The sex difference in the association between type 2 diabetes and heart failure was consistent across a range of prespecified subgroups, according to researchers.
“These findings are in agreement with the previous evidence showing that diabetes has stronger associations with diabetic complications for women than men and shed light on the importance of a routine sex-specific approach both in research and clinical practice in this field,” the researchers wrote.
They suggested several potential explanations for the increased excess risk for heart failure among women with diabetes. Diabetes may confer a higher risk for CVD among women vs. men, whereas sex differences in diabetes management could underpin the associations because, historically, women have had poorer glucose control vs. men, they wrote. Additionally, undertreatment for women with diabetes may contribute to the development of diabetic cardiomyopathy.
The researchers noted that the risk for premature death is higher for men with diabetes vs. women with diabetes, making men less likely to develop heart failure.
“There is a need for further research to understand the mechanisms underpinning this excess risk in women — particularly for type 1 diabetes — and to reduce the burden associated with diabetes in both sexes,” Ohkuma said. – by Regina Schaffer
For more information:
Toshiaki Ohkuma, MD, PhD, can be reached at the George Institute for Global Health, P.O. Box M201, Missenden Road, NSW 2050, Australia; email: etohkuma@georgeinstitute.org.au.
Disclosure: One of the authors reports he is a consultant for Amgen and Kirin.
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