Impact of gender on relative rates of cardiovascular events in patients with diabetes

Denis Angoulvant; Pierre Henri Ducluzeau; Peggy Renoult-Pierre; Grégoire Fauchier; Julien Herbert; Carl Semaan; Alexandre Bodin; Arnaud Bisson; Laurent Fauchier

doi:10.1016/j.diabet.2021.101226

Impact of gender on relative rates of cardiovascular events in patients with diabetes

Diabetes Metab. 2021 Sep;47(5):101226. doi: 10.1016/j.diabet.2021.101226. Epub 2021 Jan 14.

Authors

Denis Angoulvant¹, Pierre Henri Ducluzeau², Peggy Renoult-Pierre³, Grégoire Fauchier³, Julien Herbert⁴, Carl Semaan⁵, Alexandre Bodin⁵, Arnaud Bisson⁵, Laurent Fauchier⁵

Affiliations

¹ Service de Cardiologie, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, EA4245 T2i, France. Electronic address: d.angoulvant@chu-tours.fr.
² Service de Médecine Interne, Unité d'Endocrinologie Diabétologie et Nutrition, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France; INRA UMR 85, Unit SENSOR, 37380 Nouzilly, France.
³ Service de Médecine Interne, Unité d'Endocrinologie Diabétologie et Nutrition, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France.
⁴ Service de Cardiologie, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, EA4245 T2i, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, EA7505, France.
⁵ Service de Cardiologie, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, EA4245 T2i, France.

PMID: 33454437
DOI: 10.1016/j.diabet.2021.101226

Abstract

Aim: To investigate whether diabetes confers higher relative risks of cardiovascular events in women compared with men using contemporary data and also whether such gender-differences are dependent on age.

Methods: All patients discharged from French hospitals in 2013 with at least 5 years of follow-up and no history of major adverse cardiovascular events including heart failure (MACE-HF; heart failure, myocardial infarction, ischaemic stroke, cardiovascular death) were identified and categorized by diabetes status. Overall and age-stratified incidence rates, hazard ratios (HRs) and women-to-men ratios (WMRs) for MACE-HF leading to hospitalization were also calculated. Adjustments were then made for age and baseline characteristics according to cardiovascular risk factors and non-cardiovascular comorbidities.

Results: The study included 2,953,816 subjects, among whom 349,928 (11.9%) had diabetes. Of those with diabetes, the absolute rate of MACE-HF was higher in men than in women (96 vs 66 per 1000 person-years); corresponding absolute rates in men and women without diabetes were 44 vs 27 per 1000 person-years. Comparing those with and without diabetes, women had a higher unadjusted HR of MACE-HF (2.45, 95% CI: 2.42-2.47) than men (2.15, 95% CI: 2.14-2.17), with an adjusted WMR of 1.13 (95% CI: 1.12-1.15). HRs of MACE-HF related to diabetes were highest in women aged around 45 years and in the youngest men and decreased with advancing age in both these groups. However, HRs were higher in women of all ages > 40 years. After adjustment, this effect was more apparent for myocardial infarction (adjusted WMR: 1.43, 95% CI: 1.38-1.48) than for either ischaemic stroke (adjusted WMR: 1.10, 95% CI: 1.07-1.14) or heart failure (adjusted WMR: 1.13, 95% CI: 1.11-1.14).

Conclusion: Although men have higher absolute risks of cardiovascular complications, the relative risks of cardiovascular complications associated with diabetes are higher in women than in men.

Keywords: Cardiovascular disease; Diabetes; Gender difference; Heart failure; Myocardial infarction.

MeSH terms

Adult
Brain Ischemia*
Diabetes Mellitus* / epidemiology
Female
Heart Failure* / epidemiology
Humans
Male
Myocardial Infarction* / epidemiology
Risk Factors
Stroke* / epidemiology