Diabetes As A Risk Factor For Acute Coronary Syndrome In Women Compared With Men: A Meta-analysis

Objectives:Diabetes mellitus is a significant cause of death and disability worldwide and is a strong risk factor for acute coronary syndrome (ACS). Whether diabetes confers the same excess risk of ACS in both sexes is unknown. Therefore, we undertook a meta-analysis to estimate the relative risk for ACS associated with diabetes in men and women.Methods:We systematically searched PubMed, Embase, and Cochrane Library databases for both case-control and cohort studies published between Jan 1,1966, and Jan 1,2015. 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. We pooled the sex-specific RR and the ratio (RRR) between women and men using a random-effects model with inverse-variance weighting.Results:We included 9 case-control and 10 cohort studies with data for 10,856,279 individuals and at least 106,703 fatal and non-fatal ACS events. The pooled maximum-adjusted RR of acute coronary syndrome associated with diabetes was 2.46 (95%CI 1.92-3.17) in women and 1.68 (95%CI 1.39-2.04) in men. In patients with diabetes compared to those without diabetes, women had a significantly greater risk of ACS—the pooled women-to-men RRR was 1.38 (95%CI 1.25-1.52, p<0.001), with no evidence of publication bias.Conclusions:The excess risk of ACS associated with diabetes is significantly higher in women than men. This finding may be explained by more adverse cardiovascular risk profiles and suggests that further work is needed to clarify the relevant biological, behavioural, or social mechanisms.