Table 1.
Population studies of sex differences in CV complications in T2D.
| First author | Study design, country | Study details | Outcome measure | Relative risk of CVD in T2D versus euglycemia (95% CI) | ||
|---|---|---|---|---|---|---|
| Female | Male | Female:male ratioa | ||||
| Emerging Risk Factors Collaboration.7 | Meta-analysis of 102 prospective studies, multiple countries |
n = 698,782, 43% F T2D n = 39,295 (6%) Age: 52 ± 13 years Follow up: median 10.8 years Adjustment: age, smoking, BMI, SBP |
Coronary heart disease (fatal or non-fatal) | 2.59 (2.29–2.93) | 1.89 (1.73–2.06) | 1.37 (Pinteraction <0.0001) |
| Ischaemic stroke | 2.83 (2.35–3.40) | 2.16 (1.84–2.52) | 1.31 (Pinteraction 0.0089) | |||
| Peters et al.8 | Meta-analysis of 64 prospective studies, multiple countries |
n = 858,507, 53% F T2D n = 35 359 (4%) Age: >18 years Follow up: 5–30 years Adjustment: multiple adjusted |
Coronary heart disease (fatal or non-fatal) | 2.63 (2.27–3.06) | 1.85 (1.64–2.10) | 1.44 (1.27–1.63) |
| Peters et al.9 | Meta-analysis of 64 prospective studies, multiple countries |
n = 775,385, 53% F T2D n = 33 772 (4%) Age: >15 years Follow-up: 5–32 years Adjustment: multiple adjusted |
Stroke | 2.28 (1.93–2.69) | 1.83 (1.60–2.08) | 1.27 (1.10–1.46) |
| Shah et al.10 | CALIBER prospective study, England |
n = 1,921,260, 51% F T2D n = 34,198 (2%) Age: >30 years Follow up: median 5.5 years Adjustment: age, BMI, socioeconomic status, HDL and total cholesterol, SBP, smoking, statin and antihypertensive drug |
Non-fatal MIb | 2.68 (2.03–3.54) | 1.71 (1.45–2.45) | 1.57 (Pinteraction 0.0048) |
| PADb | 5.11 (4.05–6.44) | 3.77 (3.21–4.44) | 1.36 (Pinteraction 0.028) | |||
| Millett et al.4 | UK Biobank prospective study, UK |
n = 471,998, 56% F T2D n = 20 483 (4%) Age: 56 ± 8 years Follow up: mean 7 years Adjustment: age, SBP, socioeconomic status, smoking, BMI, lipid lowering and antihypertensive drug |
Coronary heart disease (fatal or non-fatal) | 1.96 (1.60–2.41) | 1.33 (1.18–1.51) | 1.47 (1.16–1.87) |
| Ohkuma et al.11 | Meta-analysis of 47 prospective studies, multiple countries |
n = 11,925,128 T2D n = 676 016 (6%) Age: >16 years Follow up: 3–27 years Adjustment: multiple adjusted |
Congestive heart failure | 1.95 (1.70–2.22) | 1.74 (1.55–1.95) | 1.09 (1.05–1.13) |
| Wright et al.12 | Retrospective CPRD registry study between 2006–2013, England | Cases Female: n = 35,396, age 64 ± 14 Male: n = 44,589, age 61 ± 13 Controls Female: n = 172,994, age 64 ± 14 Male: n = 213,553, age 61 ± 13 Follow up: mean 3.6 years Adjustment: age, ethnicity, deprivation, smoking, obesity, co-morbidities |
MACE (composite of MI, ischaemic stroke, CV death) | 1.20 (1.12–1.28) | 1.12 (1.06–1.19) | 1.07 (0.98–1.17) |
| MI | 1.31 (1.20–1.43) | 1.20 (1.12–1.28) | 1.09 (0.98–1.22) | |||
| Ischaemic stroke | 1.13 (1.01–1.26) | 1.04 (0.92–1.16) | 1.09 (0.93–1.28) | |||
| Malmborg et al.5 | Retrospective registry study between 2012–2016, Denmark | Cases Female: n = 69,057, age 65 years (56–74) Male: n = 79,328, age 64 years (55–71) Controls Female: n = 1,266,291, age 57 years (48–67) Male: n = 1,132,245, age 55 years (47–65) |
MACE-HF (composite of MI, ischaemic stroke, HF, CV death) | 2.90 (2.90–2.90) | 2.50 (2.40–2.50) | 1.15 (1.11–1.19) |
| MI | 2.70 (2.60–2.90) | 2.00 (2.00–2.10) | 1.34 (1.25–1.43) | |||
| Ischaemic stroke | 2.40 (2.30–2.50) | 2.20 (2.10–2.20) | 1.09 (1.03–1.15) | |||
| HF | 3.60 (3.40–3.70) | 3.20 (3.10–3.30) | 1.13 (1.07–1.19) | |||
| All-cause mortality | 2.70 (2.70–2.80) | 2.60 (2.60–2.70) | 1.03 (1.00–1.06) | |||
| Chase-Vilchez et al.13 | Meta-analysis of seven prospective studies, multiple countries |
n = 2,071,260, 50% F T2D n = 39,569 (2%) Age: 45–72 years Follow-up: 5–20 years Adjustment: multiple adjusted |
PAD | 1.96 (1.29–2.63) | 1.84 (1.29–2.86) | 1.05 (0.90–1.22) |
Age presented as median (interquartile range) or mean ± SD.
Where provided, p values for interaction with sex are presented. In meta-analyses, pooled estimates of women:men relative risk ratio were generated using random effects analysis with inverse variance weighting.
In participants younger than 60 years.
BMI, body mass index; CALIBER, CArdiovascular disease research using LInked Bespoke studies and Electronic health Records; CI, confidence interval; CPRD, Clinical Practice Research Datalink; CV, cardiovascular; CVD, cardiovascular disease; DBP, diastolic blood pressure; HDL, high-density lipoprotein; HF, heart failure; MACE, major adverse cardiovascular events; MI, myocardial infarction; PAD, peripheral arterial disease; SBP, systolic blood pressure; SD, standard deviation; T2D, type 2 diabetes; UK, United Kingdom.