Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes?
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MACROVASCULAR COMPLICATIONS IN DIABETES (VR ARODA AND L-S CHANG, SECTION EDITORS)
Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes? Jürgen Harreiter 1
&
Helena Fadl 2
&
Alexandra Kautzky-Willer 1,3
&
David Simmons 2,4
Accepted: 10 September 2020 # The Author(s) 2020
Abstract Purpose of Review This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes. Recent Findings In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher “within-gender” RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities. Summary The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women. Keywords Diabetes mellitus . Gestational diabetes . Cardiovascular disease . Sex . Gender . Prevention . Diabetes management . CVD risk factors . Lipids . Sex hormones
Introduction This article is part of the Topical Collection on Macrovascular Complications in Diabetes * Jürgen Harreiter [email protected] Helena Fadl [email protected] Alexandra Kautzky-Willer [email protected] David Simmons [email protected] 1
Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
2
Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
3
Gender Institute, Gars am Kamp, Austria
4
Macarthur Clinical School, Western Sydney University, Sydney, New South Wales, Australia
In the general population, women die at an older age than men in nearly all parts of the world such that life expectancy is on average 4 years higher among women than men [1]. These differences have been attributed to biological, socioeconomic, environmental, and behavioral factors [2–4]. Although women live longer, this advantage frequently fails to translate into increased healthy life years [5]. Cardiovascular disease (CVD) is the leading cause of death among both men and women [6]. Diabetes is a wellknown CVD risk factor and thus patients with diabetes mellitus have a high need for approaches that will reduce premature mortality from CVD. The number of people with diabetes worldwide is predicted to increase from the current
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