Sex Differences in the Excess Risk of Cardiovascular Diseases Associated with Type 2 Diabetes: Potential Explanations and Clinical Implications

Abstract

Strong evidence suggests that type 2 diabetes confers a stronger excess risk of cardiovascular diseases in women than in men; with women having a 27 % higher relative risk of stroke and a 44 % higher relative risk of coronary heart disease compared with men. The mechanisms that underpin these sex differences in the associations between diabetes and cardiovascular disease risk are not fully understood. Some of the excess risk may be the result of a sex disparity in the management and treatment of diabetes, to the detriment of women. However, accruing evidence suggests that real biological differences between men and women underpin the excess risk of diabetes-related cardiovascular risk in women such that there is a greater decline in risk factor status in women than in men in the transition from normoglycemia to overt diabetes. This greater risk factor decline appears to be associated with women having to put on more weight than men, and thus attain a higher body mass index, to develop diabetes. Further studies addressing the mechanisms responsible for sex differences in the excess risk of cardiovascular diseases associated with diabetes are needed to improve the prevention and management of diabetes in clinical practise.

Keywords: Cardiovascular disease; Coronary heart disease; Diabetes; Men; Sex differences; Stroke; Women.

Fig. 1

Prevalence (%) of diabetes in adults (20–79 years) in 2013. Figure is obtained from reference [1]

Fig. 2

Percentage growth in age-standardised diabetes prevalence, 1980–2008, by region. Reproduced, with the permission of the publisher, from reference [3]

Fig. 3

Relative risk (RR) and women:men ratio of relative risks (RRR) for coronary heart disease (CHD) and stroke in women and men with diabetes versus without diabetes. Vertical bars represent 95 % confidence intervals. Data were obtained from references [•, •]

Fig. 4

Mean body mass index by age at diagnosis of type 2 diabetes for men (black) and women (white) aged between 30 and 90 years at diagnosis and with BMI >25 kg/m² from the Scottish Care Information Diabetes Collaboration (SCI-DC) dataset. Patients who died within 2 years of BMI determination were excluded. Vertical bars represent 95 % CIs around the mean. Reproduced, with the permission of the publisher, from reference [30]