Top

Diabetologia

Published in:

Open Access 01-09-2019 | Heart Failure | Article

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

Authors: Toshiaki Ohkuma, Yuji Komorita, Sanne A. E. Peters, Mark Woodward

Published in: Diabetologia | Issue 9/2019

Abstract

Aims/hypothesis

The prevalence of diabetes and heart failure is increasing, and diabetes has been associated with an increased risk of heart failure. However, whether diabetes confers the same excess risk of heart failure in women and men is unknown. The aim of this study was to conduct a comprehensive systematic review with meta-analysis of possible sex differences in the excess risk of heart failure consequent to diabetes. Our null hypothesis was that there is no such sex difference.

Methods

A systematic search was conducted in PubMed for population-based cohort studies published between January 1966 and November 2018. Studies were selected if they reported sex-specific estimates of RRs for heart failure associated with diabetes, and its associated variability, which were adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain pooled sex-specific RRs and women-to-men ratio of RRs (RRRs) for heart failure associated with diabetes.

Results

Data from 47 cohorts, involving 12,142,998 individuals and 253,260 heart failure events, were included. The pooled multiple-adjusted RR for heart failure associated with type 1 diabetes was 5.15 (95% CI 3.43, 7.74) in women and 3.47 (2.57, 4.69) in men, leading to an RRR of 1.47 (1.44, 1.90). Corresponding pooled RRs for heart failure associated with type 2 diabetes were 1.95 (1.70, 2.22) in women and 1.74 (1.55, 1.95) in men, with a pooled RRR of 1.09 (1.05, 1.13).

Conclusions/interpretation

The excess risk of heart failure associated with diabetes is significantly greater in women with diabetes than in men with diabetes.

PROSPERO registration: CRD42019135246

Available only for authorised users

Seferovic PM, Petrie MC, Filippatos GS et al (2018) Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 20(5):853–872. https://doi.org/10.1002/ejhf.1170 CrossRefPubMed

Aune D, Schlesinger S, Neuenschwander M et al (2018) Diabetes mellitus, blood glucose and the risk of heart failure: a systematic review and meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 28(11):1081–1091. https://doi.org/10.1016/j.numecd.2018.07.005 CrossRefPubMed

Dauriz M, Targher G, Laroche C et al (2017) Association between diabetes and 1-year adverse clinical outcomes in a multinational cohort of ambulatory patients with chronic heart failure: results from the ESC-HFA heart failure long-term registry. Diabetes Care 40(5):671–678. https://doi.org/10.2337/dc16-2016 CrossRefPubMed

Johansson I, Edner M, Dahlstrom U, Nasman P, Ryden L, Norhammar A (2014) Is the prognosis in patients with diabetes and heart failure a matter of unsatisfactory management? An observational study from the Swedish Heart Failure Registry. Eur J Heart Fail 16(4):409–418. https://doi.org/10.1002/ejhf.44 CrossRefPubMed

Shah AD, Langenberg C, Rapsomaniki E et al (2015) Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1.9 million people. Lancet Diabetes Endocrinol 3(2):105–113. https://doi.org/10.1016/S2213-8587(14)70219-0 CrossRefPubMedPubMedCentral

Sattar N, Preiss D (2018) Research digest: heart failure in diabetes comes into focus. Lancet Diabetes Endocrinol 6(8):603. https://doi.org/10.1016/S2213-8587(18)30212-2 CrossRefPubMed

Regensteiner JG, Golden S, Huebschmann AG et al (2015) Sex differences in the cardiovascular consequences of diabetes mellitus: a scientific statement from the American Heart Association. Circulation 132(25):2424–2447. https://doi.org/10.1161/CIR.0000000000000343 CrossRefPubMed

Peters SA, Huxley RR, Woodward M (2014) Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia 57(8):1542–1551. https://doi.org/10.1007/s00125-014-3260-6 CrossRefPubMed

Peters SA, Huxley RR, Woodward M (2014) Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes. Lancet 383(9933):1973–1980. https://doi.org/10.1016/S0140-6736(14)60040-4 CrossRefPubMed

10.

Chatterjee S, Peters SA, Woodward M et al (2016) Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes Care 39(2):300–307. https://doi.org/10.2337/dc15-1588 CrossRefPubMed

11.

Ohkuma T, Peters SAE, Woodward M (2018) Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events. Diabetologia 61(10):2140–2154. https://doi.org/10.1007/s00125-018-4664-5 CrossRefPubMedPubMedCentral

12.

Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012. https://doi.org/10.1001/jama.283.15.2008 CrossRefPubMed

13.

American Diabetes Association (2019) Standards of medical care in diabetes-2019. Diabetes Care 42:S1–S186CrossRef

14.

Wells G, Shea B, O’Connell D et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 19 Dec 2018

15.

He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK (2001) Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 161(7):996–1002. https://doi.org/10.1001/archinte.161.7.996 CrossRefPubMed

16.

Huxley RR, Barzi F, Woo J et al (2014) A comparison of risk factors for mortality from heart failure in Asian and non-Asian populations: an overview of individual participant data from 32 prospective cohorts from the Asia-Pacific Region. BMC Cardiovasc Disord 14(1):61. https://doi.org/10.1186/1471-2261-14-61 CrossRefPubMedPubMedCentral

17.

Goyal A, Norton CR, Thomas TN et al (2010) Predictors of incident heart failure in a large insured population: a one million person-year follow-up study. Circ Heart Fail 3(6):698–705. https://doi.org/10.1161/CIRCHEARTFAILURE.110.938175 CrossRefPubMedPubMedCentral

18.

McAllister DA, Read S, Kerssens J et al (2018) Incidence of hospitalisation for heart failure and case-fatality among 3.25 million people with and without diabetes. Circulation 138(24):2774–2786. https://doi.org/10.1161/CIRCULATIONAHA.118.034986 CrossRefPubMedPubMedCentral

19.

Chen HF, Ho CA, Li CY (2019) Risk of heart failure in a population with type 2 diabetes versus a population without diabetes with and without coronary heart disease. Diabetes Obes Metab 21(1):112–119. https://doi.org/10.1111/dom.13493 CrossRefPubMed

20.

Rosengren A, Edqvist J, Rawshani A et al (2018) Excess risk of hospitalisation for heart failure among people with type 2 diabetes. Diabetologia 61(11):2300–2309. https://doi.org/10.1007/s00125-018-4700-5 CrossRefPubMedPubMedCentral

21.

Ballotari P, Venturelli F, Greci M, Giorgi Rossi P, Manicardi V (2017) Sex differences in the effect of type 2 diabetes on major cardiovascular diseases: results from a population-based study in Italy. Int J Endocrinol 2017:6039356CrossRefPubMedPubMedCentral

22.

Leung AA, Eurich DT, Lamb DA et al (2009) Risk of heart failure in patients with recent-onset type 2 diabetes: population-based cohort study. J Card Fail 15(2):152–157. https://doi.org/10.1016/j.cardfail.2008.10.004 CrossRefPubMed

23.

Policardo L, Seghieri G, Francesconi P, Anichini R, Franconi F, Del Prato S (2017) Gender difference in diabetes related excess risk of cardiovascular events: when does the ‘risk window’ open? J Diabetes Complicat 31(1):74–79. https://doi.org/10.1016/j.jdiacomp.2016.09.010 CrossRef

24.

Vimalananda VG, Biggs ML, Rosenzweig JL et al (2014) The influence of sex on cardiovascular outcomes associated with diabetes among older black and white adults. J Diabetes Complicat 28(3):316–322. https://doi.org/10.1016/j.jdiacomp.2013.12.004 CrossRef

25.

Ahmad FS, Ning H, Rich JD, Yancy CW, Lloyd-Jones DM, Wilkins JT (2016) Hypertension, obesity, diabetes, and heart failure-free survival: the cardiovascular disease Lifetime Risk Pooling Project. JACC Heart Fail 4(12):911–919. https://doi.org/10.1016/j.jchf.2016.08.001 CrossRefPubMedPubMedCentral

26.

Alexander M, Grumbach K, Selby J, Brown AF, Washington E (1995) Hospitalization for congestive heart failure. Explaining racial differences. JAMA 274(13):1037–1042. https://doi.org/10.1001/jama.1995.03530130043026 CrossRefPubMed

27.

Rosengren A, Vestberg D, Svensson AM et al (2015) Long-term excess risk of heart failure in people with type 1 diabetes: a prospective case-control study. Lancet Diabetes Endocrinol 3(11):876–885. https://doi.org/10.1016/S2213-8587(15)00292-2 CrossRefPubMed

28.

Huxley RR, Peters SA, Mishra GD, Woodward M (2015) Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 3(3):198–206. https://doi.org/10.1016/S2213-8587(14)70248-7 CrossRefPubMed

29.

Shen Y, Cai R, Sun J et al (2017) Diabetes mellitus as a risk factor for incident chronic kidney disease and end-stage renal disease in women compared with men: a systematic review and meta-analysis. Endocrine 55(1):66–76. https://doi.org/10.1007/s12020-016-1014-6 CrossRefPubMed

30.

Penno G, Solini A, Bonora E et al (2013) Gender differences in cardiovascular disease risk factors, treatments and complications in patients with type 2 diabetes: the RIACE Italian multicentre study. J Intern Med 274(2):176–191. https://doi.org/10.1111/joim.12073 CrossRefPubMed

31.

Wexler DJ, Grant RW, Meigs JB, Nathan DM, Cagliero E (2005) Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes. Diabetes Care 28(3):514–520. https://doi.org/10.2337/diacare.28.3.514 CrossRefPubMed

32.

Vaccaro O, Boemi M, Cavalot F et al (2008) The clinical reality of guidelines for primary prevention of cardiovascular disease in type 2 diabetes in Italy. Atherosclerosis 198(2):396–402. https://doi.org/10.1016/j.atherosclerosis.2007.10.026 CrossRefPubMed

33.

Nilsson PM, Theobald H, Journath G, Fritz T (2004) Gender differences in risk factor control and treatment profile in diabetes: a study in 229 Swedish primary health care centres. Scand J Prim Health Care 22(1):27–31. https://doi.org/10.1080/02813430310003264 CrossRefPubMed

34.

Petitti DB, Klingensmith GJ, Bell RA et al (2009) Glycemic control in youth with diabetes: the SEARCH for Diabetes in Youth Study. J Pediatr 155(5):668–672.e1–3. https://doi.org/10.1016/j.jpeds.2009.05.025 CrossRefPubMedPubMedCentral

35.

Boudina S, Abel ED (2007) Diabetic cardiomyopathy revisited. Circulation 115(25):3213–3223. https://doi.org/10.1161/CIRCULATIONAHA.106.679597 CrossRefPubMed

36.

Ryden L, Grant PJ, Anker SD et al (2013) ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the task force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 34(39):3035–3087. https://doi.org/10.1093/eurheartj/eht108 CrossRefPubMed

37.

Bertram MY, Vos T (2010) Quantifying the duration of pre-diabetes. Aust N Z J Public Health 34(3):311–314. https://doi.org/10.1111/j.1753-6405.2010.00532.x CrossRefPubMed

38.

Reis JP, Allen NB, Bancks MP et al (2018) Duration of diabetes and prediabetes during adulthood and subclinical atherosclerosis and cardiac dysfunction in middle age: the CARDIA study. Diabetes Care 41(4):731–738. https://doi.org/10.2337/dc17-2233 CrossRefPubMedPubMedCentral

39.

Gouni-Berthold I, Berthold HK, Mantzoros CS, Bohm M, Krone W (2008) Sex disparities in the treatment and control of cardiovascular risk factors in type 2 diabetes. Diabetes Care 31(7):1389–1391. https://doi.org/10.2337/dc08-0194 CrossRefPubMedPubMedCentral

40.

Gobl CS, Brannath W, Bozkurt L et al (2010) Sex-specific differences in glycemic control and cardiovascular risk factors in older patients with insulin-treated type 2 diabetes mellitus. Gend Med 7(6):593–599. https://doi.org/10.1016/j.genm.2010.11.003 CrossRefPubMed

41.

Duggirala MK, Cuddihy RM, Cuddihy MT, Nyman MA, Naessens JM, Pankratz VS (2005) Women with diabetes have poorer control of blood pressure than men. J Women's Health 14(5):418–423. https://doi.org/10.1089/jwh.2005.14.418 CrossRef

42.

Wannamethee SG, Papacosta O, Lawlor DA et al (2012) Do women exhibit greater differences in established and novel risk factors between diabetes and non-diabetes than men? The British Regional Heart Study and British Women’s Heart Health Study. Diabetologia 55(1):80–87. https://doi.org/10.1007/s00125-011-2284-4 CrossRefPubMed

43.

Howard BV, Cowan LD, Go O, Welty TK, Robbins DC, Lee ET (1998) Adverse effects of diabetes on multiple cardiovascular disease risk factors in women. The Strong Heart Study. Diabetes Care 21(8):1258–1265. https://doi.org/10.2337/diacare.21.8.1258 CrossRefPubMed

44.

Peters SA, Huxley RR, Woodward M (2013) Comparison of the sex-specific associations between systolic blood pressure and the risk of cardiovascular disease: a systematic review and meta-analysis of 124 cohort studies, including 1.2 million individuals. Stroke 44(9):2394–2401. https://doi.org/10.1161/STROKEAHA.113.001624 CrossRefPubMed

45.

Mongraw-Chaffin ML, Peters SA, Huxley RR, Woodward M (2015) The sex-specific association between BMI and coronary heart disease: a systematic review and meta-analysis of 95 cohorts with 1.2 million participants. Lancet Diabetes Endocrinol 3(6):437–449. https://doi.org/10.1016/S2213-8587(15)00086-8 CrossRefPubMedPubMedCentral

46.

Baena-Diez JM, Penafiel J, Subirana I et al (2016) Risk of cause-specific death in individuals with diabetes: a competing risks analysis. Diabetes Care 39(11):1987–1995. https://doi.org/10.2337/dc16-0614 CrossRefPubMed

Title: 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
Authors: Toshiaki Ohkuma
Yuji Komorita
Sanne A. E. Peters
Mark Woodward
Publication date: 01-09-2019
Publisher: Springer Berlin Heidelberg
Keywords: Heart Failure
Type 2 Diabetes
Type 1 Diabetes
Published in: Diabetologia / Issue 9/2019
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-019-4926-x

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Please log in to get access to this content

Other articles of this Issue 9/2019

Endothelial or vascular smooth muscle cell-specific expression of human NOX5 exacerbates renal inflammation, fibrosis and albuminuria in the Akita mouse

Beneficial impact of intensified multifactorial intervention on risk of stroke: outcome of 21 years of follow-up in the randomised Steno-2 Study

The impact of GDF-15, a biomarker for metformin, on the risk of coronary artery disease, breast and colorectal cancer, and type 2 diabetes and metabolic traits: a Mendelian randomisation study

Neurocognitive and behavioural outcomes in offspring exposed to maternal pre-existing diabetes: a systematic review and meta-analysis

New insights into the mechanisms of diabetic complications: role of lipids and lipid metabolism

CD40-targeted peptide proposed for type 1 diabetes therapy lacks relevant binding affinity to its cognate receptor

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials