The risk of heart failure in diabetes is significantly higher than in the general population. This appears to be particularly true for women with type 1 diabetes, whose risk of heart failure is 47% higher than that of men with this condition. In type 2 diabetes, the difference between the sexes is not quite as pronounced as an analysis of 14 cohort studies has shown.
Heart failure is a common comorbidity in diabetes. For example, 4.3-28% of patients with heart failure have type 2 diabetes and 12-57% of patients with type 2 diabetes have a form of heart failure. Cardiac insufficiency is also the second most common first manifestation of cardiovascular disease in type 2 diabetes - even more common than acute myocardial infarction or stroke. In addition, diabetics with heart failure have a significantly increased risk of premature death from heart failure.
Other comorbidities of diabetes such as coronary heart disease (CHD), myocardial infarction, stroke, dementia, and cancer have already shown that women have a significantly higher risk than men. Toshiaki Ohkuma of the George Institute for Global Health at the University of New South Wales in Sydney, Australia, and his colleagues now wanted to investigate whether there are gender differences in the risk of heart failure among diabetics.
The current analysis included 14 cohort studies that provided gender-specific information on the association between diabetes and heart failure for both women and men. Two of the studies provided data on patients with type 1 diabetes. The two cohorts studied included more than 3 million participants and more than 95,000 heart failure disorders. The data on type 2 diabetes and heart failure came from 13 studies with about 11 million participants and nearly 250,000 heart failure disease cases.
The results: Type 1 diabetes was associated with 5.15 times the risk of heart failure in women and 3.47 times the risk in men. Thus, the additional risk of developing heart failure associated with type 1 diabetes was 47% higher in women than in men.
In type 2 diabetes, gender differences were not quite as pronounced: The risk of heart failure increased by a factor of 1.95 for women and 1.74 for men. As a result, women with type 2 diabetes had a 9% higher risk of heart failure than men with type 2 diabetes. The increased risk of heart failure in women was equally detectable in all predefined subgroups.
The exact causes of gender differences can only be speculated on. Several possible reasons are cited by the authors. Previous studies have shown that women with diabetes have a higher risk of developing CHD than men with this disease. CHD is considered the most important risk factor for heart failure. The generally poorer blood glucose control in women with diabetes may also be important, as undertreatment can contribute to the development of diabetic cardiomyopathy. In addition, the prediabetic period with hyperglycemia, which may be associated with left ventricular systolic and diastolic dysfunction, is on average up to two years longer in women than in men. In addition, women with diabetes more often have additional cardiovascular risk factors than men with diabetes. This could also contribute to a higher risk increase in women. The difference between type 1 and type 2 diabetes remains unclear.
The results underline the importance of intensive diabetes treatment and prevention in women with diabetes and, of course, in men, too, the authors write. Further research is needed to decipher the mechanisms underlying these risk differences, especially in type 1 diabetes.
Source:
Toshiaki Ohkuma et al; 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; Diabetologica (2019); 62(9): 1550-1560; doi: 10,1007/s00125-019-4926-x