Link between diabetes and heart failure stronger in women than men

Researchers from The George Institute for Global Health determined that this differential was greater in type 1 than type 2 diabetes. Type 1 diabetes is associated with a 47% excess risk of heart failure in women compared to men, whilst type 2 diabetes has a 9% higher excess risk of heart failure for women than men.

The findings published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) highlights the need for further sex-specific research into diabetes and how the condition can potentially contribute to heart complications.

According to the International Diabetes Federation (IDF), currently 415 million adults world-wide live with diabetes – with approximately 199 million of them being women. The IDF expects by the year 2040 around 313 million women will be suffering from the disease. Diabetes is the ninth leading cause of death in women and claims 2.1 million female lives every year, more so than men. The number one leading cause of death for women is heart disease.

'It is already known that diabetes puts you at greater risk of developing heart failure but what our study shows for the first time is that women are at far greater risk – for both type 1 and type 2 diabetes,' said lead author and research fellow Dr Toshiaki Ohkuma from The George Institute.

'The increased risk of heart failure following a diabetes diagnosis is significantly greater in women than men which highlights the importance of intensive prevention and treatment of diabetes in women. Further research is required to understand the mechanisms underpinning the excess risk of heart failure conferred by diabetes [particularly type 1] in women and to reduce the burden associated with diabetes in both sexes.'

Key findings:
• Women with type 1 diabetes were associated with a more than 5-fold increased risk of heart failure compared with those without diabetes. For men, the risk was 3.5-fold higher.
• Corresponding increases in risks for heart failure associated with type 2 diabetes were 95% in women and 74% in men.
• Researchers also found that both type 1 and type 2 diabetes were stronger risk factors for heart failure in women than men.
• Type 1 diabetes was associated with a 47% greater excess risk of heart failure in women compared with men.
• Type 2 diabetes was associated with a 9% greater excess risk of heart failure in women than men.
*Data compiled from 10 countries: Australia, US, UK, Italy, Sweden, Canada, Japan, China, Taiwan and Korea.

According to Diabetes Australia, the prevalence of diabetes is now so widespread that it has become the major health crisis of the 21st Century. It is the largest challenge facing the Australian health system with around 1.7 million sufferers nationwide. More than 119,000 Australians are living with type 1 diabetes, an autoimmune condition, whereas 1.3 million Australians are living with type 2 diabetes, the effects of which can be exacerbated by lifestyle factors such as poor diet and lack of exercise. It’s estimated that the number of people suffering from diabetes globally will increase to 642 million by 2040.

Study co-author Dr Sanne Peters, of The George Institute for Global Health at the University of Oxford, said there are a number of reasons why women with diabetes are at greater risk of heart complications. 'Women were reported to have two years’ longer duration of prediabetes than men and this increased duration may be associated with greater excess risk of heart failure in women' said Dr Peters. 'Some major concerns are that women are also being undertreated for diabetes, are not taking the same levels of medications as men and are less likely to receive intensive care.'

The IDF reports that girls and women with diabetes experience a range of challenges. Gender roles, power imbalances, socioeconomic inequalities resulting in poor diet and lack of physical activity can all influence vulnerability to diabetes. Women’s limited access to health services and lack of pro-activity when it comes to seeking treatment for health problems can also amplify the impact of diabetes, particularly in developing countries.

Diabetes is one of the leading causes of cardiovascular disease, blindness, kidney failure and lower-limb amputation. In pregnancy, poorly controlled diabetes increases the risk of maternal and foetal complications. Women with type 2 diabetes also have a significantly increased risk of depression in comparison to men.

The George Institute has been leading gender specific research and has already shown women with diabetes have a significantly greater excess risk of stroke and coronary heart disease as well as the non-cardiovascular complications of dementia and cancer than men. It is currently investigating gender differences in stroke as well as other chronic diseases.

The full paper, '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,' can be read in Diabetologia.