High CHD risk in diabetic women confirmed

By Eleanor McDermid, Senior medwireNews Reporter

A meta-analysis confirms that the excess risk for coronary heart disease (CHD) in patients with diabetes is greater in women than men.

The study authors – Rachel Huxley (University of Queensland, Herston, Australia) and co-workers – previously showed a similar excess stroke risk among women with diabetes. They say that “taken together with these current data, there is convincing evidence that diabetes poses a greater relative risk for cardiovascular diseases in women than men.”

The researchers suggest that interventions such as increased screening for prediabetes in women and more rigorous follow-up of high-risk women, such as those with a history of gestational diabetes, “could have a substantial impact on the prevention of CHD.”

Their latest analysis includes data pooled from 64 cohort studies, which involved 858,507 participants (42% women), 28,203 of whom had an incident CHD event during follow-up that ranged from 5 to 30 years.

At baseline, 3.4% of women and 4.8% of men had diabetes, and during follow-up these participants had respective relative risks of 2.82 and 2.16 for a CHD event, compared with women and men without diabetes. These relative risks were reduced slightly to a corresponding 2.63 and 1.85 after excluding four studies that only adjusted for age, and accounted for a large proportion of between-study heterogeneity.

In most individual studies, women with diabetes had a higher relative risk for CHD than men with diabetes, giving a significant relative risk ratio of 1.44, with the same being true for fatal CHD. This difference was not affected by study characteristics, with the exception of a borderline significant effect of year of study baseline.

The effect of study year is consistent with the historical undertreatment of women with diabetes relative to men, say the researchers. However, this is unlikely to fully account for the difference between women and men.

“Indeed, there is accumulating evidence to support the hypothesis that women’s metabolic and vascular risk factor profile has to deteriorate to a greater extent, i.e. that women have to ‘travel further’, than men to become diabetic”, they write in Diabetologia.

They therefore believe that the excess CHD risk in diabetic women is caused by “a combination of both a greater deterioration in cardiovascular risk factor levels and a chronically elevated cardiovascular risk profile in the prediabetic state, driven by greater levels of adiposity in women compared with men.”

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