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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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The miRNA‐143‐3p–Sox6–Myh7 pathway is altered in obesogenic diet‐induced cardiac hypertrophy
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Blood Pressure Control and Cardiovascular/Renal Outcomes
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“However, some studies have suggested that in the presence of DM, the cardiovascular risk may be much higher in women than in men though this finding has remained controversial [24–28].”
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Gadde, K. M., Yin, X., Goldberg, R. B., Orchard, T. J., Schlögl, M., Dabelea, D., Ibebuogu, U. N., Watson, K. E., Pi-Sunyer, X., Crandall, J. P., et al. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.123.029671 · Cited by 9
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ResultVidal-Pérez, R., Otero-Raviña, F., Grigorian-Shamagian, L., et al. (2010) · Revista Española de Cardiología · doi:10.1016/s0300-8932(10)70035-x · Cited by 8
Autoimmune diabetes in adults and risk of myocardial infarction: the HUNT study in Norway
Laugsand, L. E., Janszky, I., VATTEN, L. J., Dalen, H., Midthjell, K., Grill, V., & Carlsson, S. (2016) · Journal of Internal Medicine · doi:10.1111/joim.12530 · Cited by 8
Desrois, M., Lan, C., Movassat, J., & Bernard, M. (2017) · Nutrition & Metabolism · doi:10.1186/s12986-016-0157-z · Cited by 8
“However the relative risk of cardiovascular disease incidence and mortality associated with type 2 diabetes compared with non-diabetes is stronger in women than in men [18, 19].”
BackgroundMineralocorticoids and Cardiovascular Disease in Females with Insulin Resistance and Obesity
Nayyar, M., Lastra, G., & Manrique‐Acevedo, C. (2018) · Current Hypertension Reports · doi:10.1007/s11906-018-0887-6 · Cited by 9
Hommels, T. M., Hermanides, R. S., Rasoul, S., Berta, B., Ijsselmuiden, A. J. J., Jessurun, G. A. J., Benit, E., Pereira, B., Luca, G. D., & Kedhi, E. (2019) · Cardiovascular Diabetology · doi:10.1186/s12933-019-0827-z · Cited by 8
Harding, J. L., Morton, J. I., Shaw, J. E., Patzer, R. E., McDonald, S. P., & Magliano, D. J. (2021) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfab315 · Cited by 8
Pambianco, G., Lombardero, M., Bittner, V., Forker, A., Kennedy, F., Krishnaswami, A., Mooradian, A. D., Pop‐Busui, R., Rana, J. S., Rodriguez, A., et al. (2009) · Preventive Cardiology · doi:10.1111/j.1751-7141.2008.00014.x · Cited by 8
Dotevall, A., Wilhelmsen, L., Lappas, G., & Rosengren, A. (2005) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2003.10.001 · Cited by 8
Hiperglicemia pós-prandial: tratamento do seu potencial aterogênico
Geloneze, B., Lamounier, R. N., & Coelho, O. R. (2006) · Arquivos Brasileiros de Cardiologia · doi:10.1590/s0066-782x2006001800018 · Cited by 11
Screening for the Presence of Coronary Artery Disease
Poirier, P., Dufour, R., Carpentier, A. C., & Larose, É. (2013) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2013.01.031 · Cited by 8
de Jong, M., Peters, S. A. E., de Ritter, R., Kallen, C., Sep, S. J. S., Woodward, M., Stehouwer, C. D. A., Bots, M. L., & Vos, R. C. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.617902 · Cited by 9
“Several large studies have shown that the relative risk of ischemic heart disease conferred by diabetes can be up to 50% higher in women than men (3, 5, 8).”
Cardiometabolic Risk in Hyperlipidemic Men and Women
Leutner, M., Göbl, C. S., Wielandner, A., et al. (2016) · International Journal of Endocrinology · doi:10.1155/2016/2647865 · Cited by 8
Reducing health inequalities through general practice: a realist review and action framework
Gkiouleka, A., Wong, G., Sowden, S. L., Kuhn, I. L., Moseley, A., Manji, S., Harmston, R. R., Siersbaek, R., Bambra, C. L., & Ford, J. A. (2024) · Health and Social Care Delivery Research · doi:10.3310/ytww7032 · Cited by 8
Deslandes, M., Paquin, A., Guzzetti, E., Beaudoin, J., Barriault, A., Salaün, E., & Clavel, M.-A. A. (2022) · Open Heart · doi:10.1136/openhrt-2022-002139 · Cited by 7
“All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.”
Shimizu, T., Miura, S., Takeuchi, K., et al. (2012) · Cardiology Journal · doi:10.5603/cj.2012.0114 · Cited by 7
“5 times higher than that in males [18, 19].”
BackgroundPerceptions of Physical Activity in Middle-aged Women with Type 2 Diabetes
Bosch, M. V., Wesley, E., & Strouse, S. M. (2020) · Western Journal of Nursing Research · doi:10.1177/0193945920973151 · Cited by 7
“…with type 2 diabetes (T2D), middle-aged women with the condition are simultaneously more prone to the complications of heart attack and stroke (Lee et al., 2000; Peters et al., 2014a, 2014b) and also less likely to engage in physical activity (Regensteiner et al., 2015), which is known to…”
BackgroundChakrabarti, S., Cheung, C. C., & Davidge, S. T. (2011) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.00181.2011 · Cited by 7
“Just over half of diabetes patients are women, and women with diabetes suffer much morbidity and mortality from cardiovascular diseases (32, 42).”
BackgroundHommels, T. M., Hermanides, R. S., Rasoul, S., Berta, B., Ijsselmuiden, A. J. J., Jessurun, G. A. J., Benit, E., Pereira, B., Luca, G. D., & Kedhi, E. (2019) · Netherlands Heart Journal · doi:10.1007/s12471-019-1293-7 · Cited by 7
Diabetes Mellitus and Heart Disease
Johnstonemd, M. T., & Kinzfogl, G. (2005) · Humana Press eBooks · doi:10.1385/1-59259-908-7:579 · Cited by 7
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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