Sex may play a role in diabetes-related risk for incident coronary heart disease, according to researchers.

Women with diabetes were 44% more likely to develop CHD than men with diabetes, findings from a pooled analysis of 64 prospective population-based cohort studies indicate. The study included data from 858,507 patients with 28,203 incident CHD events from 1966 to 2011.

The sex difference in diabetes-related risk for incident CHD was consistent across subgroups defined by age and region and remained unchanged after excluding non-fatal CHD events, Rachel Huxley of the School of Population Health at the University of Queensland in Australia, and colleagues reported in Diabetologia.

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“Evidence to support the existence of clinically meaningful sex differences in the relationships between certain risk factors, such as smoking and diabetes with chronic disease is becoming apparent, often with more detrimental effects of such risk factors in women than in men,” the researchers wrote.

Women with diabetes were almost three-times more likely to develop CHD compared with women without diabetes (actual relative risk, 2.82), whereas men with diabetes were only twice as likely (actual relative risk, 2.16) to develop CHD than men without diabetes.

“[T]he diabetes-related excess risk of CHD in women may be due to a combination of both a greater deterioration in cardiovascular risk factor levels and a chronically elevated cardiovascular risk profile in the prediabetic state, driven by greater levels of adiposity in women compared with men,” the researchers wrote.

Increased screening for prediabetes in women combined with more stringent follow-up among women at high risk for diabetes could aid in CHD prevention efforts, they suggested.

“Greater awareness of early symptoms of CHD in women and sex-specific therapeutic risk factor management, irrespective of the presence of diabetes, will be the best way to improve clinical outcomes in both women and men,” the researchers wrote.

They called for more studies to determine the underlying biological mechanisms responsible for sex-related differences in CHD risk among diabetes patients. 


  1. Huxley R et al. Diabetologia. 2014; doi: 10.1007/s00125-014-3260-6