Sex-specific associations between cardiovascular risk factors and myocardial infarction in patients with type 2 diabetes: The ADVANCE-ON study

Toshiaki Ohkuma, Sanne A.E. Peters, Min Jun, Stephen Harrap, Mark Cooper, Pavel Hamet, Neil Poulter, John Chalmers, Mark Woodward, The ADVANCE Collaborative Group

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)1818-1826
Number of pages9
JournalDiabetes, Obesity and Metabolism
Volume22
Issue number10
DOIs
Publication statusPublished - 1 Oct 2020
Externally publishedYes

Bibliographical note

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Keywords

  • cardiovascular disease
  • cohort study
  • macrovascular disease
  • type 2 diabetes

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    Ohkuma, T., Peters, S. A. E., Jun, M., Harrap, S., Cooper, M., Hamet, P., Poulter, N., Chalmers, J., Woodward, M., & The ADVANCE Collaborative Group (2020). Sex-specific associations between cardiovascular risk factors and myocardial infarction in patients with type 2 diabetes: The ADVANCE-ON study. Diabetes, Obesity and Metabolism, 22(10), 1818-1826. https://doi.org/10.1111/dom.14103