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Women with diabetes 44 percent more likely to develop coronary heart disease

A systematic review and meta-analysis of some 850,000 people published in Diabetologia (the journal of the European Association for the Study of Diabetes) shows that women with diabetes are 44% more likely to develop coronary heart disease (CHD) than men with diabetes independent of sex differences in the levels of other major cardiovascular risk factors.

The data used in the study stretches back almost 50 years, from 1966 to 2011, and includes 64 studies, 858,507 people and 28,203 incident CHD events. Women with diabetes were almost 3 times more likely to develop CHD (actual relative risk 2.82) compared with women without diabetes, while men with diabetes were only twice as likely (actual relative risk 2.16) to develop CHD than men without diabetes. Combining the two sets of data showed that women with diabetes were 44% more likely to develop CHD than men with diabetes even after consideration was made for sex differences in other CHD factors.

Several possible reasons for the difference are discussed by the authors. Women have, particularly in the past, been undertreated for risk factors for cardiovascular disease (evident in studies from 1985 and before). However, even in more contemporary populations, when diabetes is treated similar to men, women have generally been less likely to achieve treatment targets. The authors (along with others before them) speculate that women may have to metabolically deteriorate further than men to become diabetic, so they are at a worse starting point even before treatment begins. Furthermore, in the prediabetic state where glucose tolerance may already be impaired but does not meet all diagnostic criteria of diabetes, risk factor levels are more elevated in women than in men. For example, in the UK General Practice Research Database, the BMI of individuals at the time of diabetes diagnosis was, on average, almost two whole units higher (1.8 kg/m2) in women than in men.

The authors say: "It is conceivable, therefore, that the diabetes-related excess risk of CHD in women may be due to a combination of both a greater deterioration in cardiovascular risk factor levels and a chronically elevated cardiovascular risk profile in the prediabetic state, driven by greater levels of adiposity in women compared with men."

They add: "If confirmed, the implementation of sex-specific interventions before diabetes becomes manifest -- such as increased screening for prediabetes, especially in women, combined with more stringent follow-up of women at high risk for diabetes, such as women with a history of gestational diabetes -- could have a substantial impact on the prevention of CHD."

Source: sciencedaily.com

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