There is compelling evidence that type I and type II diabetes are both associated with a considerably greater excess risk of cardiovascular disease in women than in men. The mechanisms underlying this sex difference are not fully understood. However, a sex differential in the role of adiposity storage in the development of diabetes may be of particular importance. Using data on 480,000 individuals from the UK Biobank, we observed body size to be substantially greater in individuals with diabetes than in those without diabetes, especially for type II diabetes. Moreover, the difference in mean body size between those with and without type II diabetes was significantly larger in women than in men, but not for type I diabetes. This suggests that a greater difference in body anthropometry associated with diabetes in women compared with men might be responsible for the greater excess risk for CVD in women with type II diabetes as compared to men. Sex differences in the effect of type I diabetes and vascular events, however, are likely to be driven by mechanisms other than body anthropometry. The findings of our study contribute to our understanding of important differences between men and women in how diabetes affects cardiovascular outcomes.
Sex differences in the association between major and modifiable risk factors with cardiovascular disease
Most of the burden of cardiovascular diseases (CVD) is explained by a composite of physiological and lifestyle factors - chiefly, elevated blood pressure, obesity, diabetes, cigarette smoking, poor diet, and physical inactivity. There is increasing evidence that some of these risk factors have stronger effects on CVD in women than men. Although preventive strategies aimed at lowering the burden of these risk factors will benefit all, a sound knowledge of whether there are meaningful sex differences in relationships between traditional chronic disease risk factors and disease outcomes should help promote development of effective, sex-specific interventions. Addressing sex differences in relationships between risk factors and CVD risk is of importance from clinical and public health perspectives. Identifying significant sex differences in how risk factors relate to CVD risk should provide an impetus for targeted interventions aimed at reducing the prevalence of disease. Moreover, sex-specific estimates of disease risks associated with modifiable risk factors are essential for accurate estimation of the burden of disease due to these factors. These findings would help to inform the decision making process to maximize the efficacy of the allocation of health care resources, both in the UK and worldwide. Sex-specific estimates for the association between common lifestyle risk factors (elevated blood pressure, obesity, diabetes, cigarette smoking and a poor diet) and the risk of incident CVD will be determined. These sex-specific estimates will be used to evaluate whether or not the risk of stroke and coronary disease associated with these risk factors is similar between women and men. Analyses will be conducted in all individuals, as well as in subgroups defined by age, so as to identify sex-specific changes with ageing (for example, post-menopause), and socioeconomic status, to explore the effects of deprivation. Baseline and follow-up data on the full cohort of women and men in the UK Biobank, except those with pre-existing CVD at baseline, are requested.
|Lead investigator:||Professor Mark Woodward|
|Lead institution:||George Institute for Global Health|
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