Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 6:8:658726.
doi: 10.3389/fcvm.2021.658726. eCollection 2021.

Women With Diabetes Are at Increased Relative Risk of Heart Failure Compared to Men: Insights From UK Biobank

Sucharitha Chadalavada  1   2 , Magnus T Jensen  1   3 , Nay Aung  1   2 , Jackie Cooper  1 , Karim Lekadir  4 , Patricia B Munroe  1 , Steffen E Petersen  1   2
Affiliations

Women With Diabetes Are at Increased Relative Risk of Heart Failure Compared to Men: Insights From UK Biobank

Sucharitha Chadalavada et al. Front Cardiovasc Med. .

Abstract

Aims: To investigate the effect of diabetes on mortality and incident heart failure (HF) according to sex, in the low risk population of UK Biobank. To evaluate potential contributing factors for any differences seen in HF end-point. Methods: The entire UK Biobank study population were included. Participants that withdrew consent or were diagnosed with diabetes after enrolment were excluded from the study. Univariate and multivariate cox regression models were used to assess endpoints of mortality and incident HF, with median follow-up periods of 9 years and 8 years respectively. Results: A total of 493,167 participants were included, hereof 22,685 with diabetes (4.6%). Two thousand four hundred fifty four died and 1,223 were diagnosed or admitted with HF during the follow up periods of 9 and 8 years respectively. Overall, the mortality and HF risk were almost doubled in those with diabetes compared to those without diabetes (hazard ratio (HR) of 1.9 for both mortality and heart failure) in the UK Biobank population. Women with diabetes (both types) experience a 22% increased risk of HF compared to men (HR of 2.2 (95% CI: 1.9-2.5) vs. 1.8 (1.7-2.0) respectively). Women with type 1 diabetes (T1DM) were associated with 88% increased risk of HF compared to men (HR 4.7 (3.6-6.2) vs. 2.5 (2.0-3.0) respectively), while the risk of HF for type 2 diabetes (T2DM) was 17% higher in women compared to men (2.0 (1.7-2.3) vs. 1.7 (1.6-1.9) respectively). The increased risk of HF in women was independent of confounding factors. The findings were similar in a model with all-cause mortality as a competing risk. This interaction between sex, diabetes and outcome of HF is much more prominent for T1DM (p = 0.0001) than T2DM (p = 0.1). Conclusion: Women with diabetes, particularly those with T1DM, experience a greater increase in risk of heart failure compared to men with diabetes, which cannot be explained by the increased prevalence of cardiac risk factors in this cohort.

Keywords: UK biobank; cardiovascular; diabetes; epidemiology; heart failure; prognosis; prospective; sex.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The risk of all-cause mortality according to sex and presence of diabetes.
Figure 2
Figure 2
Risk of All-Cause Mortality and Incident Heart Failure in Diabetes. HR, hazard ratio (95% confidence interval shown).
Figure 3
Figure 3
Increased probability of incident Heart Failure in Diabetes: a multivariate analysis. HR, hazard ratio.
Figure 4
Figure 4
Association between Diabetes, Gender and Incident of Heart Failure – multivariate, competitive risk and sensitivity analysis. Forest plot demonstrating risk of HF between men and women for each subset of participants with diabetes. The multivariate cox models were adjusted for age, ethnicity, hypertension, hypercholesterolaemia, smoking, BMI, alcohol status with coronary artery disease stratified. Interaction term between sex and heart failure is significant in the T1DM group (p = 0.0001) and for the overall diabetes group (p = 0.007). Interaction term for sex and heart failure in T2DM is p = 0.1. Competing risk confirms the trend seen in the multivariate analysis, and indicates that the increased risk in women especially with T1DM is significant enough to be above all-cause mortality. T1DM, type 1 diabetes; T2DM, type 2 diabetes; HR, hazard ratio; sHR, sub-distribution hazard ratio.
See this image and copyright information in PMC

References

    1. Kaiser AMYB, Zhang N, Der Pluijm WVAN. Global Prevalence of Type 2 Diabetes over the Next Ten Years (2018–2028). Diabetes. (2018) 67(Supplement 1):202–LB. 10.2337/db18-202-LB - DOI
    1. Preis SR, Hwang SJ, Coady S, Pencina MJ, D'Agostino RB, Sr, Savage PJ, et al. . Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the framingham heart study, 1950 to 2005. Circulation. (2009) 119:1728–35. 10.1161/CIRCULATIONAHA.108.829176 - DOI - PMC - PubMed
    1. Fox CS, Coady S, Sorlie PD, D'Agostino RB, Sr, Pencina MJ, Vasan RS, et al. . Increasing cardiovascular disease burden due to diabetes mellitus: The Framingham Heart Study. Circulation. (2007) 115:1544–50. 10.1161/CIRCULATIONAHA.106.658948 - DOI - PubMed
    1. Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of Type1 and Type2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med. (2012) 29:855–62. 10.1111/j.1464-5491.2012.03698.x - DOI - PubMed
    1. Bertoni AG, Goff DC, D'Agostino RB, Liu K, Hundley WG, Lima JA, et al. . Diabetic Cardiomyopathy and Subclinical Cardiovascular Disease. Diabetes Care. (2006) 29:588 LP–594. 10.2337/diacare.29.03.06.dc05-1501 - DOI - PubMed