Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study

TLDR

The study examined the 14‑year sex‑specific impact of non‑insulin‑dependent diabetes mellitus on fatal ischemic heart disease risk in a geographically defined cohort of adults aged 40–79. A prospective cohort of 207 men and 127 women with diabetes was compared to 2,137 nondiabetic adults over 14 years of follow‑up. Diabetic men had a 1.8‑fold, and diabetic women a 3.3‑fold, increased hazard of fatal ischemic heart disease after age adjustment, and the sex difference was largely attributable to better survival among nondiabetic women. Published in JAMA 1991;265:627‑631.

Abstract

We report here the 14-year sex-specific effect of non—insulin-dependent diabetes mellitus on the risk of fatal ischemic heart disease in a geographically defined population of men and women aged 40 through 79 years. There were 207 men and 127 women who had diabetes at baseline based on medical history or fasting hyperglycemia. They were compared with 2137 adults who had fasting euglycemia and a negative personal and family history of diabetes. The relative hazard of ischemic heart disease death in diabetics vs nondiabetics was 1.8 in men and 3.3 in women, after adjusting for age, and 1.9 and 3.3, respectively, after adjusting for age, systolic blood pressure, cholesterol, body mass index, and cigarette smoking using the Cox regression model. The sex difference in the independent contribution of diabetes to fatal heart disease was largely explained by the persistently more favorable survival rate of women (than men) without diabetes. (<i>JAMA</i>. 1991;265:627-631)