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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”
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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“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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Research works printed but not linked: 2
- Kalin MF, Zumoff B: Sex hormones and coronary disease: a review of the clinical studies. Steroids 55:330-352, 1990
- Greenland S: Quantitative methods in the review of epidemiologic literature. Epi- demiol Rev 9:1-30, 1987
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“Diabetes is an important risk factor for coronary heart disease [2,3] and its complications [4–6] and leads to a significant burden of all-cause mortality [7].”
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“Previous studies have reported diabetes to increase the risk of CHD [2,4,5] and stroke [6-8] more markedly in women than in men.”
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“Furthermore, women with T2DM are at especially high risk for CVD, with a 50% increased risk of death from coronary artery disease (8), and 27% increased relative risk of stroke relative to men (9).”
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Metadata
- 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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