Acute Coronary Syndromes More Common in Women With Diabetes

Woman with chest pain
Woman with chest pain
Women with diabetes more likely to have heart disease than men.

Women with diabetes may be at a significantly greater excess risk for acute coronary syndrome compared with men with diabetes, according to a new systematic review and meta-analysis of 19 studies.

The findings were presented at EASD 2015, the annual meeting of the European Association for the Study of Diabetes.

In this study, researchers analyzed data on almost 11 million patients. Results showed that women with diabetes are approximately 40% more likely to suffer acute coronary syndromes (ACS) — heart attack or angina — than men with diabetes.

These findings should be a wake-up call for clinicians to make sure they “avoid sexual prejudice in cardiovascular disease (CVD),” according to the researchers. They said it is important to take the necessary steps to diagnose CVD early and to control risk factors in light of the significant gender differences in adult with diabetes.

Xue Dong, MD, with the Affiliated ZhongDa Hospital of Southeast University, Nanjing in China, and colleagues, systematically searched PubMed, Embase and Cochrane Library databases for both case-control and cohort studies published between 1966 and 2014. Studies were included if they reported sex-specific estimates of the relative risk (RR), hazard ratio (HR) or odds ratio (OR) for the association between diabetes and ACS and its associated variability. The researchers pooled the sex-specific RR and their ratio (RRR) between women and men.

A total of nine case-control and 10 cohort studies were included in the review. The 19 studies included 10,856,279 individuals and at least 106,703 fatal and nonfatal ACS events. Five studies were conducted in North America, seven in Europe and six in Asia. The pooled maximum-adjusted RR of ACS associated with diabetes was 2.46 in women and 1.68 in men.

In adults with diabetes, the researchers concluded that women had a 38% increased risk for ACS.

The researchers report that diabetes is a strong risk factor for ACS; however, whether diabetes confers the same excess risk for ACS between the sexes has been unknown. These new findings may have significant clinical implications due to the global epidemic of diabetes and the increasing morbidity and mortality associated with it.

In women with diabetes, it may be more important to aggressively treat CV risk factors and to develop new strategies for identifying the most suitable treatments, the researchers noted. The findings from this meta-analysis also suggest that more studies are warranted to investigate the mechanisms that may be conferring greater risk for ACS in women.


  1. Dong X et al. Abstract 269: Diabetes as a risk factor for acute coronary syndrome in women compared with men: a systematic review and meta-analysis. Presented at: EASD 2015; Sept. 14-18, 2015; Stockholm.