Introduction
Why Do Women Live longer?
Increased Mortality Risk in Women with Diabetes?
Author | Population | Design | Outcome |
---|---|---|---|
Cardiovascular mortality | |||
Xu et al. [19] | 2,314,292 individuals, among whom 254,038 all-cause deaths occurred | Systematic review and meta-analysis including prospective cohort 35 studies | Pooled women vs. men ratio of the HRs 1.17 (95% CI: 1.12–1.23) and 1.97 (1.49–2.61) respectively for all cause and coronary heart disease (CHD) mortality. increased all-cause mortality in men (HR 1.91 (1.72–2.12)) and women (2.33 (2.02–2.69)) with T2DM vs. healthy population |
Wang et al. [20] | 5,162,654 participants | Systematic review and meta-analysis including 49 studies | Higher relative all-cause mortality (RRR 1.13, 95% CI 1.07–1.19; p < 0.001) and CVD mortality (1.30, 1.13–1.49; p < 0.001) in women with diabetes vs. men with diabetes. Women with diabetes vs. men with diabetes: CHD mortality RRR 1.58, 95% CI 1.32–1.90; p < 0.001 and stroke mortality 1.08, 1.01–1.15; p < 0.001 |
Huxley et al. [21•] | 447,064 participants | Meta-analysis of 37 prospective cohort studies | Higher risk of fatal CHD in women with diabetes vs. men, pooled ratio of the RR 1.46 (1.14–1.88). Fatal CHD in patients with diabetes vs. no diabetes significantly higher in women than men: 3.50 (2.70–4.53) vs. 2.06 (1.81–2.34). |
Huxley et al. [12•] | 214,000 participants and 15,273 events | Meta-analysis of 26 studies | pooled women-to-men ratio in patients with T1DM: SMR 1.37 (95% CI 1.21–1.56) for all-cause mortality, 1.44 (1.02–2.05) increased risk for renal disease mortality, 1.37 (1.03–1.81) for stroke mortality, CVD mortality 1.86 (1.62–2.15), 2.54 (1.80–3.60) for incident coronary heart disease |
Prospective Studies Collaboration and Asia Pacific Cohort Studies Collaboration [22] | 980,793 participants and 76,965 fatalities different ethnicities and age categories, age 35–89 years | Meta-analysis of 68 prospective studies | Doubling of occlusive vascular mortality risk in men with diabetes RR 2.10, 95% CI 1.97–2.24), tripling in women with diabetes (3.00, 2.71–3.33) after stratification for age, total cholesterol, blood pressure, smoking status and BMI. Higher risks in younger groups with diabetes aged 35–59 years (2.60, 2.30–2.94) vs. older groups aged 70–89 years (2.01, 1.85–2.19), highest risk in women with diabetes and age 35 and 59 years (5.55, 4.15–7.44). in absolute numbers, adjusted diabetes associated excess occlusive vascular mortality comparable in men and women across all age categories |
Wright et al. [23] | 79,985 patients with incident T2DM between 2006 and 2013 matched to 386,547 patients without T2DM | Retrospective cohort study | Higher CVD event risk in both men and women, with a non-significant higher relative risk in women (RR 1.07 (0.98–1.17) |
Clemens et al. [13••] | 46,606 participants of trials examining the effect of diabetes medications on major adverse cardiovascular events in people ≥18 years of age with T2DM | Meta-analysis of 5 CVOTs on 3- or 4-point MACE (i.e., CV death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, hospitalization for unstable angina for 4-point MACE) | Higher risk for women for stroke (RR 1.28; 1.09–1.50), heart failure (1.30; 1.21–1.40), and CKD (1.33; 1.17–1.51), similar risk for PAD (1.12; 0.97–1.30) and lower risk for myocardial infarction (0.71; 0.59–0.86), consistently fewer female participants (28.5–35.8%) in the trials. |
Heart failure | |||
Malmborg et al. [24•] | 218,549 (46% women) participants, age 40–89 years | Population based study | Higher absolute risk of MACE-HF in men, but in relative terms 15% higher women to men ratio (95% Cl 1.11–1.19, p < 0.001) at the age of 50–60 years. The risk of recurrent CVD events or HF within 30 days irrespective of diabetes or sex, more often with increasing age. |
Ohkuma et al. [25•]. | 12,142,998 individuals and 253,260 heart failure events | Systematic review and meta-analysis of 47 cohorts | Women with diabetes have increased relative risk of heart failure vs. men: T1DM (RRR 1.47 (1.44, 1.90)), T2DM (RRR 1.09 (1.05, 1.13)) |
Kannel et al. [26]. | 5209 men and women, age 30–62 years, | Framingham study, 18 year follow up | Five- and two-fold increased risk of heart failure in women and men with diabetes respectively vs. healthy population |