Sex-specific cardiovascular risk factors and treatment in females with T2DM and CVD: developments and knowledge gaps
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PURPOSE: There are large disparities in the impact of diabetes on cardiovascular disease (CVD) risk and outcomes by sex and gender. Achieving health equity requires understanding risks and medication efficacy in female patients, especially now, as novel pharmacologic treatments are transforming the diabetes and CVD treatment landscape. This review examines 2 bodies of research that can inform sex differences in CVD in patients with diabetes: female-specific risk factors for CVD and sex-related limitations of clinical trial research in evaluating novel diabetes and CVD treatments. METHODS: Two literature searches were performed using Ovid Medline(R) All. The first retrieved manuscripts covering sex and gender differences related to CVD risk and therapies and diabetes. The second focused on randomized controlled trial data on sex/gender differences and GLP-1/SGLT-2/DPP-4 drugs. RESULTS: Female-specific risk factors for CVD include early menarche, premature or early menopause, irregular cycles and polycystic ovary syndrome; pregnancy; adverse pregnancy outcomes; history of breast cancer; and autoimmune diseases. Clinical trials of novel pharmacological treatments for diabetes and CVD have undersampled female populations, and clinical characteristics of male and female participants have differed significantly. Thus, evidence to evaluate potential sex differences in treatment efficacy and side effects has been lacking. CONCLUSION: To improve health of female patients with diabetes, sex-specific cardiovascular risk factors should be taken into account in screening and treatment decisions. Further, studies of cardiovascular and diabetes medications must ensure adequate representation by sex and report participant characteristics and outcomes by sex.
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Women with type 2 diabetes are less likely than men to receive GLP-1 receptor agonists and SGLT2 inhibitors even when clinical indications are comparable.
“A growing body of evidence indicates that women with type 2 diabetes mellitus are less likely than men to receive prescriptions for GLP-1 receptor agonists and SGLT2 inhibitors, even when clinical indications are comparable.”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [21]
The section on sex differences in prescribing practices (page not provided) reports a Danish cohort in which women and men with the same new diagnoses of T2D and CVD had different initiation rates for both drug classes. But the review also reports a meta-analysis finding no sex difference for SGLT-2 inhibitors and higher GLP-1 receptor agonist prescribing among women. The claim presents the lower prescribing rate as a broader, consistent finding than this mixed evidence supports. (LLM, conf=0.86)
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Research works printed but not linked: 1
- Grandi SM, Filion KB, Yoon S, et al. Cardiovascular disease-related morbidity and mortality in women with a history of pregnancy complications. Circulation. 2019;139(8):1069-1079.
Cited by
Sorted by citations
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“Collectively, these factors contribute to persistent gender-based disparities in optimal diabetes and cardiovascular management, underscoring the need for gender-sensitive approaches to risk stratification and treatment selection [20,21].”
- Authors
- LeBlanc, E. S., Brooks, N., Davies, M., & Chatterjee, R.
- Affiliations
- Kaiser Permanente Center for Health Research (US)
- Duke University (US)
- Corresponding author
- LeBlanc, Erin S
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2024-09-23
- Volume
- 109
- Issue
- 12
- Pages
- e2167-e2177
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W4402732441
- Cited by
- 11
- References
- 141
- Citations by year
- 2026: 9 · 2025: 2
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- sex differences, cardiovascular risk factors, type 2 diabetes, cardiovascular disease, women, GLP-1 receptor agonists, SGLT2 inhibitors, DPP-4 inhibitors, health equity, menopause, polycystic ovary syndrome, pregnancy outcomes, breast cancer, autoimmune disease, cardiovascular screening
- MeSH terms
- Heart Disease Risk Factors, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Male, Pregnancy, Risk Factors, Sex Characteristics, Sex Factors
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