| Abstract |
OBJECTIVE:
To estimate the relative risk for fatal coronary heart disease associated
with diabetes in men and women.
DESIGN: Meta-analysis of prospective cohort studies.
DATA SOURCES: 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.
REVIEW 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.
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