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Sex‐specific associations between cardiovascular risk factors and myocardial infarction in patients with type 2 diabetes: The ADVANCE‐ON study
Author(s) -
Ohkuma Toshiaki,
Peters Sanne A. E.,
Jun Min,
Harrap Stephen,
Cooper Mark,
Hamet Pavel,
Poulter Neil,
Chalmers John,
Woodward Mark
Publication year - 2020
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14103
Subject(s) - medicine , hazard ratio , diabetes mellitus , myocardial infarction , body mass index , proportional hazards model , blood pressure , type 2 diabetes , cohort , confidence interval , cohort study , relative risk , demography , cardiology , endocrinology , sociology
Aim To examine possible sex differences in the excess risk of myocardial infarction (MI) consequent to a range of conventional risk factors in a large‐scale international cohort of patients with diabetes, and to quantify these potential differences both on the relative and absolute scales. Materials and methods Eleven thousand and sixty‐five participants (42% women) with type 2 diabetes in the ADVANCE trial and its post‐trial follow‐up study, ADVANCE‐ON, were included. Cox regression models were used to estimate hazard ratios (HRs) for associations between risk factors and MI (fatal and non‐fatal) by sex, and the women‐to‐men ratio of HRs (RHR). Results Over a median of 9.6 years of follow‐up, 719 patients experienced MI. Smoking status, smoking intensity, higher systolic blood pressure (SBP), HbA1c, total and LDL cholesterol, duration of diabetes, triglycerides, body mass index (BMI) and lower HDL cholesterol were associated with an increased risk of MI in both sexes. Furthermore, some variables were associated with a greater relative risk of MI in women than men: RHRs were 1.75 (95% CI: 1.05‐2.91) for current smoking, 1.53 (1.00‐2.32) for former smoking, 1.18 (1.02‐1.37) for SBP, and 1.13 (95% CI, 1.003‐1.26) for duration of diabetes. Although incidence rates of MI were higher in men (9.3 per 1000 person‐years) compared with women (5.8 per 1000 person‐years), rate differences associated with risk factors were greater in women than men, except for HDL cholesterol and BMI. Conclusions In patients with type 2 diabetes, smoking, higher SBP and longer duration of diabetes had a greater relative and absolute effect in women than men, highlighting the importance of routine sex‐specific approaches and early interventions in women with diabetes.