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. 2023 Sep 6;30(12):1227-1235.
doi: 10.1093/eurjpc/zwad133.

Higher risk of adverse cardiovascular outcomes in females with type 2 diabetes Mellitus: an Umbrella review of systematic reviews

Clyve Yu Leon Yaow  1 , Bryan Chong  1 , Yip Han Chin  1 , Martin Tze Wah Kueh  2   3 , Cheng Han Ng  1 , Kai En Chan  1 , Ansel Shao Pin Tang  1 , Charlotte Chung  1 , Rachel Goh  1 , Gwyneth Kong  1 , Mark Muthiah  1   4   5 , Indah Sukmawati  6 , Antonia Anna Lukito  5 , Mark Y Chan  1   7 , Chin Meng Khoo  8 , Anurag Mehta  9 , Mamas A Mamas  10   11 , Georgios K Dimitriadis  12   13 , Nicholas W S Chew  1   6
Affiliations

Higher risk of adverse cardiovascular outcomes in females with type 2 diabetes Mellitus: an Umbrella review of systematic reviews

Clyve Yu Leon Yaow et al. Eur J Prev Cardiol. .

Abstract

Background: Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have excess mortality risk compared to their male counterparts. An important next step to address the high global burden of T2DM and cardiovascular disease (CVD) is an umbrella review to summarize data on sex differences in cardiovascular outcomes for patients with T2DM and assess the strength of the evidence observed.

Methods and results: Medline and Embase were searched from inception till 7 August 2022 for systematic reviews and meta-analyses studying the effects of sex on cardiovascular outcomes in T2DM patients. Results from reviews were synthesized with a narrative synthesis, with a tabular presentation of findings and forest plots for reviews that performed a meta-analysis. 27 review articles evaluating sex differences in cardiovascular outcomes were included. Females with T2DM had a higher risk of developing coronary heart disease (CHD; RRR: 1.52, 95%CI: 1.32-1.76, P < 0.001), acute coronary syndrome (ACS; RRR: 1.38, 95%CI: 1.25-1.52, P < 0.001), heart failure (RRR: 1.09, 95%CI: 1.05-1.13, P < 0.001) than males. Females had a higher risk of all-cause mortality (RRR: 1.13, 95%CI: 1.07-1.19, P < 0.001), cardiac mortality (RRR: 1.49, 95%CI: 1.11-2.00, P = 0.009) and CHD mortality (RRR: 1.44, 95%CI: 1.20-1.73, P < 0.001) as compared to males.

Conclusions: This umbrella review demonstrates that females with T2DM have a higher risk of cardiovascular outcomes than their male counterparts. Future research should address the basis of this heterogeneity and epidemiological factors for better quality of evidence, and identify actionable interventions that will narrow these sex disparities.

Keywords: Cardiovascular diseases; Diabetes mellitus; Mortality; Sex differences.

Plain language summary

This umbrella review highlights the sex differences in adverse cardiovascular events in patients with type 2 diabetes mellitus (T2DM), with females at a higher risk than males. This is contributed by both biological and healthcare disparities and underscores the need for equitable care and personalized medical therapy.Females with T2DM have a higher risk of coronary heart disease, acute coronary syndrome, heart failure, and cardiac mortality compared to males.Clinicians need to be aware of the substantial heterogeneity across the current T2DM studies, and future meta-analysis and large-scale studies examining sex differences in outcomes should attempt to address the heterogeneity and epidemiological factors for a better quality of evidence.

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Conflict of interest statement

Conflicts of interest: Mark Y. Chan: Speaker’s fees and research grants Astra Zeneca, Abbott Technologies and Boston Scientific. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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