Type 2 diabetes mellitus is associated with an increased risk of coronary heart disease (CHD), cerebrovascular disease and peripheral vascular disease (Diabetes Med Rev 1987; 3: 463-524).
A large number of studies have shown that diabetes is a stronger CHD risk factor for women than men, but only few have adjusted their results for classic CHD risk factors: age, hypertension, total cholesterol level, smoking. The objective of this study is to establish an accurate estimate of the odds ratio for fatal and non fatal CHD due to diabetes in men and women. Studies that included a non diabetic control group and provided sex specific adjusted results for CHD mortality, non fatal myocardial infarction and cardiovascular or all cause mortality have been included. Of 4578 articles identified only 16 studies have met all inclusion criteria: 12 prospective cohort studies (J Intern Med 1998; 244:309-16; Circulation 1999; 99:1165-1172; JAMA 1999; 265:627-31; Diabet Med 1996; 13:125-32; NEJM 1993; 329:73-78; Am J Epidemiol 1988; 128:389-401; Diabetes Care 1997; 20:163-9; Am J Epidemiol 1986; 123:504-16; Circulation 1990; 81:899-906; Diabetes Care 1998; 21:1167-72; Diabetes Care 1998; 21:1861-69; Diabetes Care 1992; 15:1541-49); 4 cross-sectional analyses (Diabetes 1987; 36:730-39; Diabetes Res Clin Pract 1991; 13:119-129; Diabetes Care 1998; 21:959-966; Am J Epidemiol 1992; 135:1321-1330). In unadjusted and age adjusted analyses odds of CHD death have been higher in women than in men with diabetes. From 8 prospective studies the multivariate adjusted summary odds ratio for CHD mortality due to diabetes has been 2.3 for men and 2.9 for women. There have been no significant sex differences in the adjusted risk associated with diabetes for CHD mortality, non fatal myocardial infarction and cardiovascular or all cause mortality. Absolute CHD death rates have been higher for diabetic men than women in every age except the very oldest. The difference in relative risk for CHD mortality between men and women has been attenuated with adjustment for age and other major cardiovascular risk factors. Diabetic women compared with non diabetic women may have a more severe degree of risk factor abnormalities than diabetic men compared with non diabetic men (Circulation 1994; 89:991-7) or the unfavorable cardiac risk factors may have a bigger impact on women than men, or risk factors in women are managed less aggressively than in men (Arch Intern Med 1998; 158:981-88; NEJM 1991; 325:226-30). The excess relative risk of CHD mortality in women vs men with diabetes has been absent after adjusting for classic CHD risk factors, but men had more CHD deaths attributable to diabetes than women.

Posted on January 25th 2010