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. 2023 May 22;14(1):32.
doi: 10.1186/s13293-023-00517-8.

Sex differences in cardiovascular risk, lifestyle, and psychological factors in patients with type 2 diabetes: the Fukuoka Diabetes Registry

Toshiaki Ohkuma  1 , Masanori Iwase  2   3 , Hiroki Fujii  2   4 , Takanari Kitazono  2
Affiliations

Sex differences in cardiovascular risk, lifestyle, and psychological factors in patients with type 2 diabetes: the Fukuoka Diabetes Registry

Toshiaki Ohkuma et al. Biol Sex Differ. .

Abstract

Background: The excess risk of cardiovascular diseases associated with diabetes is greater in women than in men. The present study aimed to examine sex differences in the control of cardiovascular risk factors, as well as lifestyle and psychological factors, in patients with type 2 diabetes.

Methods: A total of 4923 Japanese patients with type 2 diabetes were included in this cross-sectional study. Female/male differences in cardiovascular risk factor levels, and corresponding odds ratios for achieving recommended ranges for preventing cardiovascular diseases and having unhealthy lifestyle and psychological factors were computed by linear and logistic regression models.

Results: Women were less likely than men to achieve recommended ranges for glycated hemoglobin, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and obesity-related anthropometric indices such as body mass index and waist circumference, but were more likely than men to be on target for high-density lipoprotein cholesterol and triglycerides. Women were also more likely than men to have an unhealthy lifestyle and psychological factors, including less dietary fiber intake, less leisure-time physical activity, shorter sleep duration, more constipation, and more depressive symptoms. Similar findings were observed when the participants were subgrouped by age (< 65 and ≥ 65 years) and past history of cardiovascular disease.

Conclusions: We observed significant sex differences for a range of cardiovascular risk factors, as well as lifestyle and psychological factors, suggesting the importance of adopting a sex-specific approach for the daily clinical management of diabetes.

Keywords: Cardiovascular risk factor; Diabetes; Lifestyle; Psychosocial factor; Sex difference.

Plain language summary

Diabetes increases the risk of cardiovascular diseases, and growing evidence suggests that the risk increases more in women than men. Differences between the sexes in terms of the control of risk factors have been proposed to explain this association. Although ethnic and regional differences in the management of cardiovascular risk factors have been reported, most evidence has come from Western countries, and evidence from Asia is limited. Given the differences in health care systems, as well as cultural and sociological backgrounds, it is important to clarify the sex differences in the management of cardiovascular risk factors, lifestyle, and psychological factors in order to incorporate appropriate sex-specific approaches into public health policies.The present study comprehensively assessed sex differences in a wide range of cardiovascular risk factors, as well as lifestyle and psychological factors in Japanese patients with type 2 diabetes. The results showed that women were less likely than men to achieve recommended ranges for glycemic control, low-density lipoprotein-cholesterol and non-high-density lipoprotein-cholesterol, as well as obesity-related anthropometric indices, but were more likely to be on target for high-density lipoprotein-cholesterol and triglycerides. In addition, women were more likely to have unhealthy lifestyle and psychological factors, such as less dietary fiber intake, less physical activity, shorter sleep duration, and more constipation, and depressive symptoms. These results suggest the need for a comprehensive and sex-specific approach for the management of cardiovascular risk factors, as well as lifestyle and psychological factors, to reduce the risk of cardiovascular diseases in patients with diabetes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cardiovascular risk factor levels in men and women. Mean values and female/male differences adjusted for age. Mean levels presented as mean (standard error). Triglycerides presented as geometric mean (95% CI), and differences calculated after log-transformation among participants with available data for fasting values (n: women = 1929, men = 2512). Six participants with missing values for defecation frequency were excluded from the analysis of constipation. BMI body mass index, BP blood pressure, CES-D Center for Epidemiologic Studies Depression, CI confidence interval, HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, LTPA leisure-time physical activity, TG triglycerides
Fig. 2
Fig. 2
Achievement of recommended ranges for cardiovascular risk factors in men and women. *Female/male odds ratios adjusted for age. **LDL-C < 2.59 mmol/L in participants with a history of coronary heart disease, < 3.11 mmol/L in those without a history of coronary heart disease. ***Non-HDL-C < 3.37 mmol/L in participants with a history of coronary heart disease, < 3.89 mmol/L in those without a history of coronary heart disease. Triglycerides evaluated among participants with available data for fasting values (n: women = 1929, men = 2512). Six participants with missing values for defecation frequency were excluded from the analysis of constipation. BMI body mass index, BP blood pressure, CES-D Center for Epidemiologic Studies Depression, CI confidence interval, HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, LTPA leisure-time physical activity, TG triglycerides
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References

    1. American Diabetes Association Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023;46(Suppl 1):S1–S284. - PubMed
    1. Peters SA, Huxley RR, Woodward M. Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia. 2014;57(8):1542–1551. doi: 10.1007/s00125-014-3260-6. - DOI - PubMed
    1. Peters SA, Huxley RR, Woodward M. Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes. Lancet. 2014;383(9933):1973–1980. doi: 10.1016/s0140-6736(14)60040-4. - DOI - PubMed
    1. Ohkuma T, Komorita Y, Peters SAE, Woodward M. Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals. Diabetologia. 2019;62(9):1550–1560. doi: 10.1007/s00125-019-4926-x. - DOI - PMC - PubMed
    1. Ohkuma T, Peters SAE, Woodward M. Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events. Diabetologia. 2018;61(10):2140–2154. doi: 10.1007/s00125-018-4664-5. - DOI - PMC - PubMed

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