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
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
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DOI：
10.1007/s00125-014-3260-6
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发表时间：
2014-08-01
期刊：
影响因子：
8.2
通讯作者：
Woodward, Mark
中科院分区：
文献类型：
--
作者：
Peters, Sanne A. E.;Huxley, Rachel R.;Woodward, Mark
先前的汇总分析表明，与受影响的男性相比，患有糖尿病的女性患致命性CHD的风险大幅增加。从那时起，几项更大规模和更现代的研究的其他发现已经发表在糖尿病和冠心病事件之间的性别特异性关联上。我们进行了一项更新的系统性综述和荟萃分析，以提供糖尿病对后续CHD风险影响的任何性别差异的最可靠证据。PubMed MEDLINE系统检索了1966年1月1日至2013年2月13日期间发表的前瞻性基于人群的队列研究。合格的研究必须报告与糖尿病相关的冠心病事件的性别特异性RR估计值及其相关变异性，至少已根据年龄进行调整。采用随机效应荟萃分析和方差反加权法获得性别特异性RR和与糖尿病相关的CHD事件的RR比（RRR）（女性：男性），纳入了64个队列，包括858，507例个体和28，203例CHD事件。与非糖尿病患者相比，女性与男性糖尿病相关冠心病事件的RR分别为2.82（95% CI 2.35，3.38）和2.16（95% CI 1.82，2.56）。女性糖尿病患者冠心病的多重校正相对危险度比男性糖尿病患者高44%（RRR1.44 [95%CI 1.27，1.63]），研究间无显著异质性（I（2）= 20%），女性糖尿病患者冠心病的发生风险比男性糖尿病患者高40%以上。药物治疗中的性别差异不太可能解释女性的过度风险，但未来的研究有必要更清楚地阐明糖尿病相关冠心病风险中存在显著性别差异的机制。
A previous pooled analysis suggested that women with diabetes are at substantially increased risk of fatal CHD compared with affected men. Additional findings from several larger and more contemporary studies have since been published on the sex-specific associations between diabetes and incident CHD. We performed an updated systematic review with meta-analysis to provide the most reliable evidence of any sex difference in the effect of diabetes on subsequent risk of CHD.PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between 1 January 1966 and 13 February 2013. Eligible studies had to have reported sex-specific RR estimates for incident CHD associated with diabetes and its associated variability that had been adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain sex-specific RRs and the RR ratio (RRR) (women:men) for incident CHD associated with diabetes.Data from 64 cohorts, including 858,507 individuals and 28,203 incident CHD events, were included. The RR for incident CHD associated with diabetes compared with no diabetes was 2.82 (95% CI 2.35, 3.38) in women and 2.16 (95% CI 1.82, 2.56) in men. The multiple-adjusted RRR for incident CHD was 44% greater in women with diabetes than in men with diabetes (RRR 1.44 [95% CI 1.27, 1.63]) with no significant heterogeneity between studies (I (2) = 20%).Women with diabetes have more than a 40% greater risk of incident CHD compared with men with diabetes. Sex disparities in pharmacotherapy are unlikely to explain much of the excess risk in women, but future studies are warranted to more clearly elucidate the mechanisms responsible for the substantial sex difference in diabetes-related risk of CHD.