Diabetes as a risk factor for stroke in women compared with men: A systematic review and meta-analysis of 64 cohorts, including 775 385 individuals and 12 539 strokes

The Lancet (Impact Factor: 45.22). 03/2014; 383(9933). DOI: 10.1016/S0140-6736(14)60040-4
Source: PubMed


Diabetes mellitus is a major cause of death and disability worldwide and is a strong risk factor for stroke. Whether and to what extent the excess risk of stroke conferred by diabetes differs between the sexes is unknown. We did a systematic review and meta-analysis to estimate the relative effect of diabetes on stroke risk in women compared with men.
We systematically searched PubMed for reports of prospective, population-based cohort studies published between Jan 1, 1966, and Dec 16, 2013. Studies were selected if they reported sex-specific estimates of the relative risk (RR) for stroke associated with diabetes, and its associated variability. We pooled the sex-specific RRs and their ratio comparing women with men using random-effects meta-analysis with inverse-variance weighting.
Data from 64 cohort studies, representing 775 385 individuals and 12 539 fatal and non-fatal strokes, were included in the analysis. The pooled maximum-adjusted RR of stroke associated with diabetes was 2·28 (95% CI 1·93-2·69) in women and 1·83 (1·60-2·08) in men. Compared with men with diabetes, women with diabetes therefore had a greater risk of stroke-the pooled ratio of RRs was 1·27 (1·10-1·46; I(2)=0%), with no evidence of publication bias. This sex differential was seen consistently across major predefined stroke, participant, and study subtypes.
The excess risk of stroke associated with diabetes is significantly higher in women than men, independent of sex differences in other major cardiovascular risk factors. These data add to the existing evidence that men and women experience diabetes-related diseases differently and suggest the need for further work to clarify the biological, behavioural, or social mechanisms involved.

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    • "been reported to be increased during the course of diabetes (Peters et al., 2014). Moreover, after acute limb ischemia or foot ulcers, diabetics appear to have both higher mortality and an increased rate of amputation (Jeffcoate and Harding, 2003). "
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    • "This translates to a 44% greater increase in relative risk for coronary heart disease in women with diabetes compared to men [18]. A second meta-analysis examining 64 cohorts with 777,385 individuals by the same author showed a 25% increase in relative risk for stroke in women compared with men with diabetes [19] emphasizing the differential effects of diabetes on vascular health in women compared with men. The authors further suggest that this difference may be secondary to differences between men and women in level of metabolic changes needed to occur prior to sufficient impairment in glucose tolerance in women for the diagnosis of diabetes, thus more women spend a greater amount of time in the pre-diabetic state when compared with men [18]. "

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