|Application:||2495, Sex differences in the association between major and modifiable risk factors with cardiovascular disease|
|Title:||Diabetes, glycated haemoglobin and the risk of myocardial infarction in women and men: a prospective cohort study of the UK Biobank.|
|Archived:||21 May 2021|
|Personal:||No individual-level data|
This item is regarded as restricted and will be supplied to researchers only when absolutely necessary.
OBJECTIVE Diabetes has shown to be a stronger risk factor for myocardial infarction (MI) in women than men. Whether sex differences exist across the glycemic spectrum is unknown. We investigated sex differences in the associations of diabetes status and glycated hemoglobin (HbA1c) with the risk of MI.
RESEARCH DESIGN AND METHODS Data were used from 471,399 (56% women) individuals without cardiovascular disease (CVD) included in the UK Biobank. Sex-specific incidence rates were calculated by diabetes status and across levels of HbA1c using Poisson regression. Cox proportional hazards analyses estimated sex-specific hazard ratios (HRs) and women-to-men ratios by diabetes status and HbA1c for MI during a mean follow-up of 9 years.
RESULTS Women had lower incidence rates of MI than men, regardless of diabetes status or HbA1c level. Compared with individuals without diabetes, prediabetes, undiagnosed diabetes, and previously diagnosed diabetes were associated with an increased risk of MI in both sexes. Previously diagnosed diabetes was more strongly associated with MI in women (HR 2.33 [95% CI 1.96; 2.78]) than men (1.81 [1.63; 2.02]), with a women-to-men ratio of HRs of 1.29 (1.05; 1.58). Each 1% higher HbA1c, independent of diabetes status, was associated with an 18% greater risk of MI in both women and men.
CONCLUSIONS Although the incidence of MI was higher in men than women, the presence of diabetes is associated with a greater excess relative risk of MI in women. However, each 1% higher HbA1c was associated with an 18% greater risk of MI in both women and men.
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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