Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals
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AIMS/HYPOTHESIS: The prevalence of diabetes and heart failure is increasing, and diabetes has been associated with an increased risk of heart failure. However, whether diabetes confers the same excess risk of heart failure in women and men is unknown. The aim of this study was to conduct a comprehensive systematic review with meta-analysis of possible sex differences in the excess risk of heart failure consequent to diabetes. Our null hypothesis was that there is no such sex difference. METHODS: A systematic search was conducted in PubMed for population-based cohort studies published between January 1966 and November 2018. Studies were selected if they reported sex-specific estimates of RRs for heart failure associated with diabetes, and its associated variability, which were adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain pooled sex-specific RRs and women-to-men ratio of RRs (RRRs) for heart failure associated with diabetes. RESULTS: Data from 47 cohorts, involving 12,142,998 individuals and 253,260 heart failure events, were included. The pooled multiple-adjusted RR for heart failure associated with type 1 diabetes was 5.15 (95% CI 3.43, 7.74) in women and 3.47 (2.57, 4.69) in men, leading to an RRR of 1.47 (1.44, 1.90). Corresponding pooled RRs for heart failure associated with type 2 diabetes were 1.95 (1.70, 2.22) in women and 1.74 (1.55, 1.95) in men, with a pooled RRR of 1.09 (1.05, 1.13). CONCLUSIONS/INTERPRETATION: The excess risk of heart failure associated with diabetes is significantly greater in women with diabetes than in men with diabetes. PROSPERO registration: CRD42019135246.
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The association between diabetes and increased heart failure risk is observed in people with type 2 diabetes and also evident in people with type 1 diabetes.
“This association is not only observed in people with type 2 diabetes but also evident in people with type 1 diabetes (216,217).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [217]
People with diabetes are at an increased risk for developing heart failure, as shown in multiple longitudinal, observational studies.
“People with diabetes are at an increased risk for developing heart failure, as shown in multiple longitudinal, observational studies (216,217).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [217]
People with diabetes are at increased risk for developing heart failure, as shown in multiple longitudinal, observational studies.
“People with diabetes are at an increased risk for developing heart failure, as shown in multiple longitudinal, observational studies (205,206).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [206]
The association between diabetes and increased heart failure risk is observed in both type 2 and type 1 diabetes.
“This association is not only observed in people with type 2 diabetes but also evident in people with type 1 diabetes (205,206).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [206]
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- Authors
- Ohkuma, T., Komorita, Y., Peters, S. A. E., & Woodward, M.
- Affiliations
- Royal Prince Alfred Hospital (AU)
- Kyushu University (JP)
- The George Institute for Global Health (GB)
- Johns Hopkins University (US)
- Corresponding author
- Ohkuma, Toshiaki
- Peters, Sanne A. E.
- Venue
- Diabetologia
- Published
- 2019-07-18
- Volume
- 62
- Issue
- 9
- Pages
- 1550-1560
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC6677875
- OpenAlex
- W2960917570
- Cited by
- 279
- References
- 49
- Citations by year
- 2026: 25 · 2025: 30 · 2024: 49 · 2023: 47 · 2022: 43 · 2021: 46 · 2020: 38 · 2019: 1
- FWCI
- 5.79
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Diabetologia (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Funders
- University of Oxford
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes mellitus, heart failure, sex differences, type 1 diabetes, type 2 diabetes, women, men, relative risk, cardiovascular risk
- MeSH terms
- Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Heart Failure, Humans, Male, Risk Factors, Sex Factors
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