Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies.
OBJECTIVE
To estimate the relative risk for fatal coronary heart disease associated with diabetes in men and women.


METHODS
Meta-analysis of prospective cohort studies.


METHODS
Studies published between 1966 and March 2005, identified through Embase and Medline, using a combined text word and MESH heading search strategy, in addition to studies from the Asia Pacific Cohort Studies Collaboration.


METHODS
Studies were eligible if they had reported estimates of the relative risk for fatal coronary heart disease comparing men and women with and without diabetes. Studies were excluded if the estimates were not adjusted at least for age.


RESULTS
37 studies of type 2 diabetes and fatal coronary heart disease among a total of 447,064 patients were identified. The rate of fatal coronary heart disease was higher in patients with diabetes than in those without (5.4 v 1.6%). The overall summary relative risk for fatal coronary heart disease in patients with diabetes compared with no diabetes was significantly greater among women than it was among men: 3.50, 95% confidence interval 2.70 to 4.53 v 2.06, 1.81 to 2.34. After exclusion of the eight studies that had adjusted only for age, the difference in risk between the sexes was substantially reduced but still highly significant. The pooled ratio of the relative risks (women: men) from the 29 studies with multiple adjusted estimates was 1.46 (1.14 to 1.88).


CONCLUSIONS
The relative risk for fatal coronary heart disease associated with diabetes is 50% higher in women than it is in men. This greater excess coronary risk may be explained by more adverse cardiovascular risk profiles among women with diabetes, combined with possible disparities in treatment that favour men.
Huxley
Rachel
R
George Institute for International Health, University of Sydney, PO Box M201, Sydney, NSW 2050, Australia. rhuxley@thegeorgeinstitute.org
Barzi
Federica
F
Woodward
Mark
M
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors