Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies
Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies
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DOI：
10.1136/bmj.38678.389583.7c
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发表时间：
2006-01-14
影响因子：
105.7
通讯作者：
Woodward, M
中科院分区：
文献类型：
--
作者：
Huxley, R;Barzi, F;Woodward, M
目的评估男性和女性糖尿病相关致死性冠心病的相对危险度。设计前瞻性队列研究的Meta分析。数据来源研究发表于1966年至2005年3月，通过Embase和Medline识别，使用联合文本词和MESH标题搜索策略，除了亚太队列研究协作组织的研究外，如果研究报告了对男性和女性致死性冠心病相对风险的估计，患有和不患有糖尿病的女性。研究被排除，如果估计没有调整至少年龄。结果37个研究2型糖尿病和致死性冠心病共447064例患者被确定。糖尿病患者的致死性冠心病发生率高于非糖尿病患者（5.4%比1.6%）。糖尿病患者与非糖尿病患者相比，女性致死性冠心病的总体相对风险显著高于男性：3.50，95%置信区间2.70 - 4.53 v2.06，1.81 - 2.34。在排除了仅根据年龄调整的8项研究后，性别之间的风险差异大大减少，但仍然非常显著。29项研究的相对危险度（女性：男性）的合并比为1.46（1.14至1.88）。结论女性糖尿病相关致死性冠心病的相对危险度比男性高50%。这种更大的过度冠状动脉风险可能是由女性糖尿病患者中更不利的心血管风险特征以及治疗中可能存在的有利于男性的差异来解释的。
Objective To estimate the relative risk for fatal coronary heart disease associated with diabetes in men and women.Design Meta-analysis of prospective cohort studies.Data sources Studies published between 1966 and March 2005, identified through Embase and Medline, using a combined text word and MESH heading search strategy, in addition to studies from the Asia Pacific Cohort Studies Collaboration.Review methods Studies were eligible if they had reported estimates of the relative risk for fatal coronary heart disease comparing men and women with and without diabetes. Studies were excluded if the estimates were not adjusted at least for age.Results 37 studies of type 2 diabetes and fatal coronary heart disease among a total of 447 064 patients were identified. The rate of fatal coronary heart disease was higher in patients with diabetes than in those without (5.4 v 1.6%). The overall summary relative risk for fatal coronary heart disease in patients with diabetes compared with no diabetes was significantly greater among women than it was among men: 3.50, 95% confidence interval 2.70 to 4.53 v 2.06, 1.81 to 2.34. After exclusion of the eight studies that had adjusted only for age, the difference in risk between the sexes was substantially reduced but still highly significant. The pooled ratio of the relative risks (women:men) from the 29 studies with multiple adjusted estimates was 1.46 (1.14 to 1.88).Conclusions The relative risk for fatal coronary heart disease associated with diabetes is 50% higher in women than it is in men. This greater excess coronary risk may be explained by more adverse cardiovascular risk profiles among women with diabetes, combined with possible disparities in treatment that favour men.