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Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events.

Abstract

AIMS/HYPOTHESIS

A previous pooled analysis suggested that women with diabetes are at substantially increased risk of fatal CHD compared with affected men. Additional findings from several larger and more contemporary studies have since been published on the sex-specific associations between diabetes and incident CHD. We performed an updated systematic review with meta-analysis to provide the most reliable evidence of any sex difference in the effect of diabetes on subsequent risk of CHD.

METHODS

PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between 1 January 1966 and 13 February 2013. Eligible studies had to have reported sex-specific RR estimates for incident CHD associated with diabetes and its associated variability that had been adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain sex-specific RRs and the RR ratio (RRR) (women:men) for incident CHD associated with diabetes.

RESULTS

Data from 64 cohorts, including 858,507 individuals and 28,203 incident CHD events, were included. The RR for incident CHD associated with diabetes compared with no diabetes was 2.82 (95% CI 2.35, 3.38) in women and 2.16 (95% CI 1.82, 2.56) in men. The multiple-adjusted RRR for incident CHD was 44% greater in women with diabetes than in men with diabetes (RRR 1.44 [95% CI 1.27, 1.63]) with no significant heterogeneity between studies (I (2) = 20%).

CONCLUSIONS/INTERPRETATION

Women with diabetes have more than a 40% greater risk of incident CHD compared with men with diabetes. Sex disparities in pharmacotherapy are unlikely to explain much of the excess risk in women, but future studies are warranted to more clearly elucidate the mechanisms responsible for the substantial sex difference in diabetes-related risk of CHD.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.

    ,

    Source

    Diabetologia 57:8 2014 Aug pg 1542-51

    MeSH

    Coronary Disease
    Diabetes Mellitus, Type 2
    Female
    Humans
    Incidence
    Male
    Risk Factors
    Sex Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Systematic Review

    Language

    eng

    PubMed ID

    24859435

    Citation

    Peters, Sanne A E., et al. "Diabetes as Risk Factor for Incident Coronary Heart Disease in Women Compared With Men: a Systematic Review and Meta-analysis of 64 Cohorts Including 858,507 Individuals and 28,203 Coronary Events." Diabetologia, vol. 57, no. 8, 2014, pp. 1542-51.
    Peters SA, Huxley RR, Woodward M. Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia. 2014;57(8):1542-51.
    Peters, S. A., Huxley, R. R., & Woodward, M. (2014). Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia, 57(8), pp. 1542-51. doi:10.1007/s00125-014-3260-6.
    Peters SA, Huxley RR, Woodward M. Diabetes as Risk Factor for Incident Coronary Heart Disease in Women Compared With Men: a Systematic Review and Meta-analysis of 64 Cohorts Including 858,507 Individuals and 28,203 Coronary Events. Diabetologia. 2014;57(8):1542-51. PubMed PMID: 24859435.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. AU - Peters,Sanne A E, AU - Huxley,Rachel R, AU - Woodward,Mark, Y1 - 2014/05/25/ PY - 2014/02/25/received PY - 2014/04/17/accepted PY - 2014/5/27/entrez PY - 2014/5/27/pubmed PY - 2015/2/24/medline SP - 1542 EP - 51 JF - Diabetologia JO - Diabetologia VL - 57 IS - 8 N2 - AIMS/HYPOTHESIS: A previous pooled analysis suggested that women with diabetes are at substantially increased risk of fatal CHD compared with affected men. Additional findings from several larger and more contemporary studies have since been published on the sex-specific associations between diabetes and incident CHD. We performed an updated systematic review with meta-analysis to provide the most reliable evidence of any sex difference in the effect of diabetes on subsequent risk of CHD. METHODS: PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between 1 January 1966 and 13 February 2013. Eligible studies had to have reported sex-specific RR estimates for incident CHD associated with diabetes and its associated variability that had been adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain sex-specific RRs and the RR ratio (RRR) (women:men) for incident CHD associated with diabetes. RESULTS: Data from 64 cohorts, including 858,507 individuals and 28,203 incident CHD events, were included. The RR for incident CHD associated with diabetes compared with no diabetes was 2.82 (95% CI 2.35, 3.38) in women and 2.16 (95% CI 1.82, 2.56) in men. The multiple-adjusted RRR for incident CHD was 44% greater in women with diabetes than in men with diabetes (RRR 1.44 [95% CI 1.27, 1.63]) with no significant heterogeneity between studies (I (2) = 20%). CONCLUSIONS/INTERPRETATION: Women with diabetes have more than a 40% greater risk of incident CHD compared with men with diabetes. Sex disparities in pharmacotherapy are unlikely to explain much of the excess risk in women, but future studies are warranted to more clearly elucidate the mechanisms responsible for the substantial sex difference in diabetes-related risk of CHD. SN - 1432-0428 UR - https://www.unboundmedicine.com/medline/citation/24859435/full_citation L2 - https://dx.doi.org/10.1007/s00125-014-3260-6 DB - PRIME DP - Unbound Medicine ER -