Affiliation:
1. Department of Epidemiology School of Public Health and Tropical Medicine, Tulane University New Orleans Louisiana USA
2. Obstetrical Department, Women's Hospital, Zhejiang University School of Medicine Hangzhou China
3. Section of Endocrinology and Metabolism, Tulane University School of Medicine New Orleans Louisiana USA
4. Southeast Louisiana Veterans Health Care System New Orleans Louisiana USA
5. Department of Nutrition Harvard T.H. Chan School of Public Health Boston Massachusetts USA
Abstract
AbstractAimWomen with diabetes are at higher risk of cardiovascular diseases (CVD) than men with diabetes; however, the sex difference in the association between the degree of risk factor control and the risk of CVD in patients with diabetes is unclear.MethodsIn total, 17 260 participants diagnosed with diabetes from the UK Biobank were included and matched with 86 300 non‐diabetes controls based on age, sex and assessment centre. The main exposure was the number of risk factors within the target range, including glycated haemoglobin level <53 mol/mol (7%), blood pressure <140/90 mm/Hg, low‐density lipoprotein cholesterol <100 mg/dl, non‐current smoking and absence of microalbuminuria.ResultsDuring a median follow‐up of 13.3 years, a total of 3338 incident CVD cases, including 2807 ischaemic heart disease and 793 strokes, were documented. A more stringent control of risk factors was significantly associated with a lower risk of incident CVD, and such an association was significantly stronger in women than men. Compared with non‐diabetes participants, the diabetes‐related risk of CVD appeared to be eliminated if more than three risk factors were well controlled among women and men with diabetes. Moreover, clinical biomarkers (e.g. glycated haemoglobin and blood pressure) showed greater relative importance than other factors in women, whereas socio‐economic and psychological factors (e.g. education and depression) exhibited similar relative importance to clinical biomarkers in men with diabetes.ConclusionOur findings highlighted the importance of raising awareness of sex differences in the management of CVD risk factors among patients with diabetes.
Funder
National Heart, Lung, and Blood Institute
National Institute of Diabetes and Digestive and Kidney Diseases
Subject
Endocrinology,Endocrinology, Diabetes and Metabolism,Internal Medicine
Reference41 articles.
1. IDF diabetes atlas – 10TH edition.https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf. Accessed 03 Jan 2021.
2. IDF diabetes atlas: global, regional and country‐level diabetes prevalence estimates for 2021 and projections for 2045;Sun H;Diabetes Res Clin Pract,2021
3. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
4. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people
5. Efficacy of cholesterol-lowering therapy in 18 686 people with diabetes in 14 randomised trials of statins: a meta-analysis