Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus - A meta-analysis
Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus - A meta-analysis
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DOI：
10.1001/archinte.162.15.1737
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发表时间：
2002-08-12
影响因子：
--
通讯作者：
Barrett-Connor, E
中科院分区：
文献类型：
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作者：
Kanaya, AM;Grady, D;Barrett-Connor, E
背景资料：大多数研究表明，糖尿病是女性冠心病（CHD）的一个较强的危险因素，但很少有研究将其结果与年龄、高血压、总胆固醇水平和吸烟等典型CHD危险因素进行校正。目的：建立一个准确的估计男性和女性糖尿病所致的致死性和非致死性CHD的比值比。我们比较了男性和女性糖尿病患者冠心病死亡率的总体优势比和冠心病死亡率的绝对优势比。我们检索了MEDLINE和科克伦协作数据库和相关文献的参考书目，并咨询了专家。纳入的研究包括非糖尿病对照组，并提供了CHD死亡率、非致死性心肌梗死、心血管或全因死亡率的性别特异性校正结果。在识别的4578篇文章中，232篇包含原始数据，182篇被排除。两名审查员记录数据的研究特点，质量和结果从50 study.Results：16项研究符合所有纳入标准。在未经校正和年龄校正的分析中，女性糖尿病患者冠心病死亡的几率高于男性。在8项前瞻性研究中，男性和女性糖尿病导致的CHD死亡率的多变量校正汇总比值比分别为2.3（95%置信区间，1.9-2.8）和2.9（95%置信区间，2.2-3.8）。与糖尿病相关的冠心病死亡率、非致死性心肌梗死、心血管或全因死亡率的校正风险没有显著的性别差异。绝对冠心病死亡率高于糖尿病男性比女性在每个年龄层，除了最古老的。结论：多余的相对风险的冠心病死亡率在女性与男性糖尿病是不存在的经典冠心病危险因素调整后，但男性有更多的冠心病死亡归因于糖尿病比女性。
Background: Most studies suggest that diabetes is a stronger coronary heart disease (CHD) risk factor for women than men, but few have adjusted their results for classic CHD risk factors: age, hypertension, total cholesterol level, and smoking.Objective: To establish an accurate estimate of the odds ratio for fatal and nonfatal CHD due to diabetes in both men and women.Methods: We compared the summary odds ratio for CHD mortality and the absolute rates of CHD mortality in men and women with diabetes. We searched the MEDLINE and Cochrane Collaboration databases and bibliographies of relevant articles and consulted experts. Studies that included a nondiabetic control group and provided sex-specific adjusted results for CHD mortality, nonfatal myocardial infarction, an l cardiovascular or all-cause mortality were included. Of 4578 articles identified, 232 contained primary data, and 182 were excluded. Two reviewers recorded data on study characteristics, quality, and outcomes from 50 studies.Results: Sixteen studies met all inclusion criteria. In unadjusted and age-adjusted analyses, odds of CHD death were higher in women than men with diabetes. From 8 prospective studies, the multivariate-adjusted summary odds ratio for CHD mortality due to diabetes was 2.3 (95% confidence interval, 1.9-2.8) for men and 2.9 (95% confidence interval, 2.2-3.8) for women. There were no significant sex differences in the adjusted risk associated with diabetes for CHD mortality, nonfatal myocardial infarction, and cardiovascular or all-cause mortality. Absolute CHD death rates were higher for diabetic men than women in every age strata except the very oldest.Conclusions: The excess relative risk of CHD mortality in women vs men with diabetes was absent after adjusting for classic CHD risk factors, but men had more CHD deaths attributable to diabetes than women.