A systematic review and meta-analysis of 19 studies containing almost 11 million patients shows that diabetic women are around 40% more likely to suffer acute coronary syndromes (heart attack or angina) than diabetic men. The study is by Dr Xue Dong, the Affiliated ZhongDa Hospital of Southeast University, Nanjing, China, and colleagues, and is presented at this year's annual meeting of the European Association for the Study of Diabetes (EASD) in Stockholm.
Diabetes is a strong risk factor for acute coronary syndrome, yet whether diabetes confers the same excess risk of acute coronary syndrome between the sexes is unknown. In this study, the authors undertook a systematic review and meta-analysis to estimate the relative risk for acute coronary syndrome associated with diabetes in men and women. They systematically searched PubMed, Embase, and Cochrane Library databases for both case-control and cohort studies published between 1966 and 2014. Studies were included if they reported sex-specific estimates of the relative risk (RR), hazard ratio (HR), or odds ratio (OR) for the association between diabetes and acute coronary syndrome, and its associated variability. They then pooled the sex-specific RR and their ratio (RRR) between women and men.
A total of 9 case-control and 10 cohort studies were included, with data for 10,856,279 individuals and at least 106703 fatal and non-fatal acute coronary syndrome events. There were 5 studies were conducted in North America, 7 in Europe, and 6 in Asia, including countries such as Canada, the United States, China and Germany. The pooled maximum-adjusted RR of acute coronary syndrome associated with diabetes was 2.46 in women and 1.68 in men. In patients with diabetes, women therefore had a significantly greater risk of acute coronary syndrome, with a 38% increased risk for women.
The authors say: "Women with diabetes have a roughly 40% greater excess risk of acute coronary syndrome, compared with men with diabetes."
They add: "We should avoid sexual prejudice in cardiovascular disease, take all necessary steps to diagnose it early, and control risk factors comprehensively to guarantee the most suitable treatments and best possible outcomes in female patients."