Diabetes-associated heart failure risk greatest in women
medwireNews: Diabetes is a stronger risk factor for heart failure among women compared with men, indicate the results of a large systematic review and meta-analysis.
“It is already known that diabetes puts you at greater risk of developing heart failure but what our study shows for the first time is that women are at far greater risk – for both type 1 and type 2 diabetes,” said lead author Toshiaki Ohkuma (The George Institute for Global Health, Sydney, New South Wales, Australia) in a press release.
The type 1 diabetes analysis included two studies involving a total of more than 3 million people and 95,129 heart failure events, while the type 2 diabetes part of the investigation included 13 studies of almost 12 million people and 249,560 events.
As reported in Diabetologia, the presence of type 1 diabetes was associated with a significant 5.15-fold increased risk for heart failure among women, and a 3.47-fold increased risk among men, after adjustment for multiple potentially confounding factors.
These findings translated into a significant 47% greater excess risk for type 1 diabetes-associated heart failure among women than men, say Ohkuma et al.
The association between type 2 diabetes and heart failure was also stronger among women than men, but the excess risk was smaller than that for type 1 diabetes, at 9%. Type 2 diabetes was associated with a 1.95- and 1.74-fold increased risk for heart failure among women and men, respectively.
Ohkuma and team say that “[t]here are several potential explanations for the greater excess risk of heart failure associated with diabetes in women compared with men.” Firstly, “the observed sex differences could be driven by there being a greater risk of CHD [coronary heart disease] conferred by diabetes in women than men, because CHD is a major cause of heart failure in people with type 2 diabetes,” they suggest.
The researchers also speculate that undertreatment of diabetes in women could “contribute to the development of diabetic cardiomyopathy,” which could lead to a stronger association between diabetes and heart failure among women, and hypothesize that a longer duration of prediabetes among women could also play a role.
They say that the reason for the higher excess risk for type 1 than type 2 diabetes among women is “unclear,” but “may be partly explained by the […] sex differences in the association between diabetes and CHD.”
And the team concludes: “Further research is required to understand the mechanisms underpinning the excess risk of heart failure conferred by diabetes (particularly type 1) in women and to reduce the burden associated with diabetes in both sexes.”
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