Eighteen years of follow-up shows that men are twice as likely to die from heart disease as women. However, this gender gap is markedly reduced when only patients with diabetes are considered. Eighteen years of follow-up show that men have twice the risk of ischemic heart disease (IHD) mortality as women. However, diabetes is a stronger risk factor for IHD mortality for women than men, so the gender gap in IHD mortality narrows in the presence of diabetes, investigators report.
Dr. Ane Cecilie Dale, of the Norwegian University of Science and Technology in Trondheim, and colleagues report data from HUNT 1, a large population-based observational study in which all residents of Trendelag County, Norway, who were older than 20 years of age at baseline were invited to participate.
The study involved 74,914 individuals, 2,100 of whom had prevalent diabetes. Over an 18-year period, 19,967 subjects died.
The hazard ratio (HR) for fatal IHD was 2.20 for men compared with women, when subjects did not have diabetes or cardiovascular disease (CVD) at baseline.
The HR was 1.25 for men compared with women when diabetes was present in both sexes.
When both diabetes and IHD were present, the risk of fatal IHD was statistically the same for men and women (HR = 1.1).
"We found that the positive association between diabetes and IHD mortality was consistently stronger in women than in men, resulting in a substantial reduction in the mortality gap between genders that is usually observed," the investigators write.
Diabetes could cause more rapid atherogenesis in women, greater tendencies to lipid abnormalities and more frequent endothelial dysfunction than in men, the researchers hypothesize.
"Our results argue for more aggressive IHD risk factor intervention in women with diabetes," Dr. Dale’s team concludes.
Eur Heart J Dec, 2007;28:2924-2929.