Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies
Open accessAbstract
OBJECTIVE: Women are at a much lower risk of coronary disease mortality than men are. It is widely believed that diabetes "erases" this female advantage, increasing the risk of heart disease much more in women than in men. In reality, the extent of this increased risk is controversial, with studies showing conflicting results and wide confidence intervals. Clarification of this issue has implications for the pathogenesis of coronary disease, and for public health efforts to reduce coronary disease in women. RESEARCH DESIGN AND METHODS: We performed a meta-analysis to calculate a summary estimate of the relative risk of coronary death among women with diabetes as compared to those without. For comparison, we also calculated the analogous risk among men. All prospective cohort studies containing both men and women, and both patients with and without diabetes, were examined. Sixteen studies were identified; 10 had sufficient data for statistical analysis. RESULTS: After combining studies that adjusted for other cardiac risk factors, the relative risk of coronary death from diabetes was 2.58 (95% CI 2.05-3.26) for women and 1.85 (1.47-2.33) for men. This difference is statistically significant (P = 0.045). Other sensitivity analyses did not change these estimates appreciably. CONCLUSIONS: The impact of diabetes on the risk of coronary death is significantly greater for women than men. Further research is required to explain this clinically meaningful difference between the sexes.
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T2DM is associated with a two-fold higher risk of CAD and ischaemic stroke.
“T2DM is associated with a two-fold higher risk of CAD and ischaemic stroke”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [141]
T2DM is associated with a two-to four-fold higher CAD- and stroke-related mortality.
“and a two-to four-fold higher CAD-and stroke-related mortality.139 -141”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [141]
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“Obesity is associated with diabetic retinopathy in older patients with male-female differences [32-34].”
BackgroundBostick, B., Habibi, J., DeMarco, V. G., Jia, G., Domeier, T. L., Lambert, M. D., Aroor, A. R., Nistala, R., Bender, S. B., Garro, M., et al. (2015) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00898.2014 · Cited by 78 · see citing works
“CARDIOVASCULAR DISEASE (CVD) is the leading cause of morbidity and mortality in obese, insulin-resistant, type 2 diabetic individuals (29, 40, 61).”
BackgroundRole of Fibric Acid Derivatives in the Management of Risk Factors for Coronary Heart Disease
Després, J., Lemieux, I., & Robins, S. J. (2004) · Drugs · doi:10.2165/00003495-200464190-00003 · Cited by 76 · see citing works
Scaling Up Chronic Disease Prevention Interventions in Lower- and Middle-Income Countries
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“6 times more likely to die of coronary disease than are their counterparts without diabetes (52).”
BackgroundImpact of diabetes on mortality in peripheral artery disease: a meta‐analysis
Vrsalović, M., Vučur, K., Presečki, A. V., Fabijanić, D., & Milošević, M. (2016) · Clinical Cardiology · doi:10.1002/clc.22657 · Cited by 73 · see citing works
“These findings are in line with previously published meta-analysis on the prognostic role of diabetes in ischemic heart disease and cerebrovascular disease.(27,28) Further prospective studies are needed to evaluate the prognostic role of diabetes in the whole spectrum of symptomatic and asymptomatic patients with peri…”
ResultJaddou, H. Y., Batieha, A. M., Khader, Y. S., Kanaan, A., El-Khateeb, M. S., & Ajlouni, K. M. (2011) · International Journal of Hypertension · doi:10.4061/2011/828797 · Cited by 73 · see citing works
“However, meta-analysis studies [37, 38] indicate that the odds of CHD mortality were significantly higher among diabetic women, as compared with diabetic men.”
Bird, C. E., Fremont, A. M., Bierman, A. S., Wickstrom, S. L., Shah, M., Rector, T. S., Horstman, T., & Escarce, J. J. (2007) · Women s Health Issues · doi:10.1016/j.whi.2007.03.001 · Cited by 70 · see citing works
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Metabolic Syndrome and Cardiometabolic Risk Factors
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Risk of Acute Complications of Diabetes Among People With Schizophrenia in Ontario, Canada
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“The prevalence of coronary artery disease is 2 to 3 times greater in people with DM, compared to individuals without DM (34, 35).”
BackgroundWalker, J. J., Colhoun, H. M., Livingstone, S. J., McCrimmon, R. J., Petrie, J. R., Sattar, N. A., & Wild, S. H. (2017) · Diabetologia · doi:10.1007/s00125-017-4478-x · Cited by 60 · see citing works
“A major contributor to premature death in people with diabetes is CHD, and previous work suggests that diabetes is a more influential risk factor for coronary death in women than in men [30].”
BackgroundExpanding the definition of a positive family history for early-onset coronary heart disease
Scheuner, M. T., Whitworth, W. C., McGruder, H. F., et al. (2006) · Genetics in Medicine · doi:10.1097/01.gim.0000232582.91028.03 · Cited by 62 · see citing works
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“” There is widespread acceptance that diabetes is a major risk factor for cardiovascular disease [2,32-34], but there have been varying estimates of absolute risk [3].”
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“Diabetes patients have a two to four-fold increased risk for cardiovascular disease compared to the general population [1-3].”
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“For diabetes, stronger associations for women than men have been confirmed by meta-analysis [24].”
BackgroundSex Differences in the Effects of Type 2 Diabetes on Exercise Performance
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“mortality than that in men with diabetes, and most but not all previous data suggest that women with T2D have a more pronounced exercise impairment than that of men with T2D (5,7,16,22,24,33).”
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Current diagnostic concepts to detect coronary artery disease in women
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Cardiovascular Risk Stratification and Management in Pre-Diabetes
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Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta.
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- Authors
- Lee, W. L., Cheung, A. M., Cape, D., & Zinman, B.
- Affiliations
- University of Toronto (CA)
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2000-07-01
- Volume
- 23
- Issue
- 7
- Pages
- 962-968
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W1992229080
- Cited by
- 442
- References
- 0
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 7 · 2023: 12 · 2022: 16 · 2021: 9 · 2020: 11 · 2019: 14 · 2018: 23 · 2017: 12 · 2016: 15 · 2015: 29 · 2014: 31 · 2013: 31 · 2012: 26
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Canadian Institutes of Health Research (44917)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- diabetes mellitus, coronary artery disease, coronary heart disease mortality, sex differences, women, men, cardiovascular risk, relative risk
- MeSH terms
- Coronary Disease, Diabetic Angiopathies, Female, Humans, Male, Risk, Risk Factors, Sex Characteristics
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