Service de Cardiologie, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, EA4245 T2i, France.
Service de Médecine Interne, Unité d'Endocrinologie Diabétologie et Nutrition, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France; INRA UMR 85, Unit SENSOR, 37380 Nouzilly, France.
Diabetes Metab. 2021 Sep;47(5):101226. doi: 10.1016/j.diabet.2021.101226. Epub 2021 Jan 14.
To investigate whether diabetes confers higher relative risks of cardiovascular events in women compared with men using contemporary data and also whether such gender-differences are dependent on age.
All patients discharged from French hospitals in 2013 with at least 5 years of follow-up and no history of major adverse cardiovascular events including heart failure (MACE-HF; heart failure, myocardial infarction, ischaemic stroke, cardiovascular death) were identified and categorized by diabetes status. Overall and age-stratified incidence rates, hazard ratios (HRs) and women-to-men ratios (WMRs) for MACE-HF leading to hospitalization were also calculated. Adjustments were then made for age and baseline characteristics according to cardiovascular risk factors and non-cardiovascular comorbidities.
The study included 2,953,816 subjects, among whom 349,928 (11.9%) had diabetes. Of those with diabetes, the absolute rate of MACE-HF was higher in men than in women (96 vs 66 per 1000 person-years); corresponding absolute rates in men and women without diabetes were 44 vs 27 per 1000 person-years. Comparing those with and without diabetes, women had a higher unadjusted HR of MACE-HF (2.45, 95% CI: 2.42-2.47) than men (2.15, 95% CI: 2.14-2.17), with an adjusted WMR of 1.13 (95% CI: 1.12-1.15). HRs of MACE-HF related to diabetes were highest in women aged around 45 years and in the youngest men and decreased with advancing age in both these groups. However, HRs were higher in women of all ages > 40 years. After adjustment, this effect was more apparent for myocardial infarction (adjusted WMR: 1.43, 95% CI: 1.38-1.48) than for either ischaemic stroke (adjusted WMR: 1.10, 95% CI: 1.07-1.14) or heart failure (adjusted WMR: 1.13, 95% CI: 1.11-1.14).
Although men have higher absolute risks of cardiovascular complications, the relative risks of cardiovascular complications associated with diabetes are higher in women than in men.
利用当代数据探讨糖尿病女性与男性相比发生心血管事件的相对风险是否更高，以及这种性别差异是否依赖于年龄。
2013 年，所有在法国医院出院且至少有 5 年随访且无主要不良心血管事件（MACE-HF；心力衰竭、心肌梗死、缺血性卒中和心血管死亡）史的患者均根据糖尿病状况进行了识别和分类。还计算了 MACE-HF 导致住院的总体和年龄分层发生率、风险比（HR）和女性与男性比值（WMR）。然后根据心血管危险因素和非心血管合并症，对年龄和基线特征进行了调整。
研究纳入了 2953816 名患者，其中 349928 名（11.9%）患有糖尿病。在患有糖尿病的患者中，男性的 MACE-HF 绝对发生率高于女性（96 比 66/1000 人年）；在无糖尿病的男性和女性中，相应的绝对发生率分别为 44 比 27/1000 人年。与患有和不患有糖尿病的患者相比，女性发生 MACE-HF 的未调整 HR 更高（2.45，95%CI：2.42-2.47），男性（2.15，95%CI：2.14-2.17），调整后的 WMR 为 1.13（95%CI：1.12-1.15）。糖尿病相关的 MACE-HF 的 HR 在 45 岁左右的女性和最年轻的男性中最高，并且在这两组中随着年龄的增长而降低。然而，在所有年龄>40 岁的女性中，HR 更高。调整后，心肌梗死的影响更为明显（调整后的 WMR：1.43，95%CI：1.38-1.48），而缺血性卒中和心力衰竭的影响则较低（调整后的 WMR：1.10，95%CI：1.07-1.14；调整后的 WMR：1.13，95%CI：1.11-1.14）。
尽管男性发生心血管并发症的绝对风险较高，但与糖尿病相关的心血管并发症的相对风险在女性中高于男性。
