Women with type 2 diabetes and coronary artery disease have a higher risk of heart failure than men, with a significant gender interaction between heart failure risk and risk factor management: a retrospective registry study

Abstract

Introduction: Women are generally perceived to have a lower risk of cardiovascular events than men, despite a lack of data, particularly among patients with diabetes. Here, we investigated gender differences in the risk of heart failure (HF) events in patients with type 2 diabetes and coronary artery disease (CAD). We also assessed the association between cardiovascular risk factor management and HF events.

Research design and methods: This retrospective registry study enrolled consecutive patients with both type 2 diabetes and CAD, based on angiography records and medical charts at 70 teaching hospitals in Japan, from January 2005 to December 2015.

Results: The registry included 7785 patients with a mean follow-up period of 1328 days. The mean age of the patients was 67.6 years. The risk of hospitalization for HF in patients with both type 2 diabetes and CAD was significantly higher among women than among men (HR, 1.26, 95% CI 1.06 to 1.50). The relationship between HF risk and achieved low-density lipoprotein cholesterol (LDL-c) and systolic blood pressure, but not hemoglobin A_1c, differed between women and men, with statistically significant interactions (p=0.009 and p=0.043, respectively).

Conclusions: Women with type 2 diabetes and CAD have a higher risk of HF than men. A significant gender interaction was observed in the association between HF risk and risk factor management, particularly regarding LDL-c and systolic blood pressure. The effectiveness of risk factor management may differ between men and women regarding HF prevention among patients with type 2 diabetes and CAD.

Keywords: Diabetes Mellitus, Type 2; Heart Failure; Sex Characteristics.

Figure 1

Incidence of hospitalization for heart failure. Kaplan-Meier curves showing the cumulative incidence of heart failure. Men: solid line; women: dashed line; both were with type 2 diabetes and established coronary artery disease.

Figure 2

Risk factor management and HR of hospitalization for HF. The relationship between the stratified SBP (mm Hg) (A), HbA_1c (% and mmol/mol) (B), and LDL-c (mg/dL) (C) during the observation period and risk of HF in women and men, stratified by the corresponding reference value. HbA_1c, glycosylated hemoglobin A_1c; HF, heart failure; HR, heart rate; LDL-c, low-density lipoprotein cholesterol; SBP, systolic blood pressure.