Risk of cardiovascular disease in women with diabetes mellitus Is it indeed higher than in men?

P. Anagnostis, V. Athyros, I.F. Godsland, A. Karagiannis



Accumulating body of evidence supports a greater relative risk for cardiovascular disease (CVD) events and mortality in diabetic women (in comparison with non-diabetic women) than in diabetic men. In contrast, conflicting data exist with respect to differences between diabetic genders regarding the absolute CVD risk. In general, heterogeneity between studies exists and the main question whether there is a definite difference in CVD risk between sexes at a given glycaemic state cannot be answered yet. Similar data, although to a lesser extent have been reported for prediabetes. In an effort to support this gender gap and loss of estrogen protection in diabetic states, some mechanisms have been proposed, such as a difference in the degree and impact of severe CVD risk factors, such as worse lipidaemic profile, higher systemic inflammation indexes, less adherence to treatment and greater failure to achieve lipid and blood pressure targets in women and a worse impact of diabetes itself on the endothelium in women. Large prospective studies representative of the general population are needed in order to define the differences between genders regarding CVD events and mortality at a given glucose level and after adjusting for age, diabetes duration and other confounders. The aim of this review is to define if there is indeed higher CVD risk in women with diabetes compared with men and elucidate possible pathogenetic mechanisms.