Women and men with diabetes have different degrees of heart risks, researchers reported from a meta-analysis.
Among more than 12 million people analyzed in published studies, women with type 1 diabetes had more than five times the risk for heart failure than in women free of diabetes (risk ratio 5.15, 95% CI 3.43-7.74), reported Toshiaki Ohkuma, PhD, of the University of New South Wales in Australia, and colleagues.
Although men with type 1 diabetes also had a significantly higher risk of heart failure compared with men free of diabetes, its magnitude wasn’t quite as high as for the women (RR 3.47, 95% CI 2.57-4.69), the team wrote in Diabetologia.
Women and men with type 2 diabetes also saw a significantly higher risk for developing heart failure at some point, although this risk was lower than in people with type 1 diabetes. Women with type 2 diabetes had a nearly two times higher risk for heart failure (RR 1.95, 95% CI 1.70-2.22); men had a slightly smaller point estimate for the increased risk (RR 1.74, 95% CI 1.55-1.95).
In a pooled analysis comparing women and men, women with either type 1 or type 2 diabetes saw significantly higher risks for developing heart failure (ratio of RR 1.47, 95% CI 1.14-1.90, for type 1; RRR 1.09, 95% CI 1.05-1.13, for type 2).
“It is already known that diabetes puts you at greater risk of developing heart failure, but what our study shows for the first time is that women are at far greater risk — for both type 1 and type 2 diabetes,” said Ohkuma in a statement.
His group conducted a systemic review of population cohort studies in PubMed spanning from 1966 through 2018. The meta-analysis included 14 relevant studies from the review — two of which included individuals with type 1 diabetes and 13 of which included people with type 2 diabetes.
In the pooled risk analysis between women and men, the risk differences reported between the sexes didn’t differ according to the location of the study, the year the study was conducted, or whether diabetes was self-reported.
Possible Reasons for the Risk Differences
What might be accounting for this heart failure risk difference between the sexes? “Women were reported to have 2 years’ longer duration of prediabetes than men, and this increased duration may be associated with greater excess risk of heart failure in women,” study co-author Sanne Peters, PhD, of the University of Oxford in the U.K., explained in a statement.
“Some major concerns are that women are also being undertreated for diabetes, are not taking the same levels of medications as men, and are less likely to receive intensive care,” she continued.
She and her colleagues speculated that the risk difference could also be driven by women’s higher risk for heart disease, in addition to typically having poorer glycemic control than men.
“It might be also possible that the sex differences found in this study are a mathematical artifact caused by the relatively low absolute risk for heart failure in women compared with men,” the researchers said. “Suppose that the absolute risk difference following diabetes is the same in men as it is in women, then there would automatically be a larger RR among women compared with men. However, RRs, rather than absolute risk differences, are much more commonly reported in clinical studies, given their stability across different populations.”
Nonetheless, Ohkuma noted how these findings highlight the importance of both “intensive prevention and treatment” for diabetes, specifically in women: “Further research is required to understand the mechanisms underpinning the excess risk of heart failure conferred by diabetes — particularly type 1 — in women and to reduce the burden associated with diabetes in both sexes,” he said.
Woodward reported being a consultant to Amgen and Kirin; no other disclosures were reported.
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Source: MedicalNewsToday.com
