- Women with diabetes are at a higher risk of heart failure than men
- Type 1 diabetes results in a higher risk than Type 2 diabetes
- More research will shed light on why women are at a higher risk
Diabetes increases the risk of heart failure more in women than in men, as per new research from the George Institute for Global Health. The study indicates that Type 1 diabetes results in a 47 percent excess risk of heart failure in women compared to men, whereas in the case of Type 2 diabetes, this value is 9 percent.
The study was conducted by Dr. Toshiaki Ohkuma, PhD, who is a Visiting Fellow at the George Institute for Global Health, University of New South Wales, Australia and Dr. Sanne Peters, PhD, who is a Research Fellow in Epidemiology at the George Institute for Global Health, University of Oxford, UK.
The study, published in Diabetologia, examines sex differences in the excess risk of heart failure arising from diabetes.
Study BackgroundIt is well established that diabetes and heart failure are co-morbid conditions that can occur simultaneously. Diabetes not only increases the risk of heart failure, but also increases the chances of death. Interestingly, in Type 2 diabetic patients, heart failure is the second most common initial symptom of cardiovascular disease (CVD). This is even more common than stroke or heart attack. Importantly, the incidence of heart failure is expected to rise in the coming years, thereby necessitating early preventive measures.
Key Features of the StudyThis was a systematic review and meta-analysis that included observational cohort studies extracted from the PubMed database. The key features of the study are highlighted below:
- Inclusion Criteria: Studies having data on the sex-specific risk of heart failure associated with diabetes in both males and females
- Exclusion Criteria:
- Existing underlying diseases
- Data on only one sex
- Unaccounted confounders such as age
- Sex-specific data on relative risks for heart failure were extracted
- Data on diabetic and non-diabetic patients were compared
- 5,991 articles were initially screened
- 14 studies had relevant data on sex differences in heart failure and diabetes
- Data on Type 1 diabetes and heart failure were available from 2 studies, involving 2 cohorts, including 3,284,123 individuals and 95,129 heart failure events
- Data on Type 2 diabetes and heart failure were available from 13 studies, involving 47 cohorts, including 11,925,128 individuals and 249,560 heart failure events
Major Findings of the StudyThe major findings of the study are indicated below:
Type 1 Diabetes:
- Associated with a 5.15 times higher risk of heart failure in women
- Associated with a 3.47 times higher risk of heart failure in men
- Excess relative risk of heart failure for women compared to men - 47 percent
- Associated with a 1.95 times higher risk of heart failure in women
- Associated with a 1.74 times higher risk of heart failure in men
- Excess relative risk of heart failure for women compared to men - 9 percent
- Diabetic men had a higher risk of premature death than diabetic women, resulting in a reduced risk of developing heart failure
- Diabetic women had a higher risk of heart failure in case of Type 1 diabetes than Type 2 diabetes
Interpretation of the Study FindingsThe study findings indicate that diabetic women have an increased risk of heart failure compared to diabetic men. These findings can be explained based on the following facts:
- Diabetes leads to a higher risk of CHD in women, which is a major cause of heart failure
- Diabetes management exhibits sex differences - women have poorer control of blood glucose levels than men, which increase the chances of heart failure
- Suboptimal treatment of diabetes in women can result in diabetic cardiomyopathy, which can lead to heart failure
- Prediabetic stage, which precedes full-blown diabetes, is much longer in women (up to 2 years longer), which enhances the risk of heart failure
- Other cardiovascular risk factors are higher in diabetic women, which could significantly increase the risk of heart failure
Strengths of the StudyThe major strengths of the study include the following:
- Large sample size (n=12 million)
- Inclusion of data from a large number of studies (n=14) and cohorts (n=47)
- Exclusion of single-sex studies
Limitations of the StudyThe major limitations of the study include the possibility of the existence of unmeasured confounding factors, as well as unavailability of data on the following parameters:
- Duration of diabetes
- Blood glucose levels
- Use of antidiabetic drugs
- Type of heart failure
Concluding RemarksThe authors conclude: "The excess risk of heart failure following a diagnosis of diabetes is high in both sexes, but significantly greater in women than men, highlighting the importance of intensive prevention and treatment of diabetes for women as well as men."
The authors indicate that further in-depth research is needed to elucidate the reason for this excess risk in women, especially in the case of Type 1 diabetes.
- Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals - (https://doi.org/10.1007/s00125-019-4926-x)