Cardiovascular Disease Risk Lower in Women With Type 2 Diabetes

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There was no difference in initiation of insulin or any co-interventional antihyperglycemic therapy or incidence of hypoglycemia between men and women.
There was no difference in initiation of insulin or any co-interventional antihyperglycemic therapy or incidence of hypoglycemia between men and women.

Women with type 2 diabetes had significantly lower rates of important new cardiovascular (CV) events compared with men after a median follow-up of 3 years, despite having a worse CV risk factor profile at baseline and lower use of indicated medications, according to new findings published in Diabetes, Obesity and Metabolism.

Men have a higher risk than women for CV events, but previous data have found that the advantage for women is not maintained in the setting of type 2 diabetes. In this study, the authors looked at gender differences in baseline characteristics and outcomes in patients with type 2 diabetes who also had atherosclerotic CV disease (ASCVD).

The Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) was a randomized, placebo-controlled trial that examined effect of sitagliptin on CV outcomes in patients with type 2 diabetes with established ASCVD. A total of 4297 women and 10,374 men were followed for a median of 3.0 years. At baseline, female participants were less likely to use aspirin or statin drugs.

The study's primary composite end point of CV death, myocardial infarction, stroke, or hospitalization for unstable angina was observed in 418 women (9.7%) vs 1272 men (12.3%; 3.48 vs 4.38 events/100 participant-years, crude hazard ratio [HR], 0.79; 95% CI, 0.71-0.89; adjusted HR, 0.64; 95% CI, 0.55-0.74; P <.0001). Women also had a lower incidence of CV death (1.58 vs 1.74 events/100 participant-years [adjusted HR, 0.55; 95% CI, 0.42-0.71; P< .0001]) and all-cause death (2.18 vs 2.56 events/100 participant-years [adjusted HR, 0.54; 95% CI, 0.43-0.67; P <.0001]) compared with men.

“These findings suggest that the cardioprotective effect of female sex may be maintained despite a diagnosis of diabetes and the presence of ASCVD,” write the authors.

Reference

Alfredsson J, Green JB, Stevens SR, et al; TECOS Study Group. Sex differences in management and outcomes of patients with type 2 diabetes and cardiovascular disease: a report from TECOS [published online June 19, 2018]. Diabetes Obes Metab. doi: 10.1111/dom.13377

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