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What Impact Does Gender Have on Heart Disease and Mortality In Type 2 Diabetes?

by Kirti Salunkhe, MD

Cardiovascular disease (CVD) is the primary cause of death in men and women and type 2 diabetes (T2D) is considered the most common non-communicable disease globally.1-2  Statistics from the Centers for Disease Control (CDC) have shown in the US, over 600,000 people die annually from heart disease (1 in every 4 deaths) and T2D is the seventh leading cause for mortality.1-2 Healthcare costs associated with these conditions are also staggering: annual US expenditure for heart disease was approximately $200 billion; whereas, it exceeded $245 billion for diabetes.1-2

Managing conditions of heart disease and T2D, individually, are often challenging for both the patient and clinician. Unfortunately, however, they are found concurrently in many individuals and require skillful supervision. Adding to this, is the fact that studies have also shown that the effect of T2D on CVD seems to be different for men and women.3-5 While data show that women generally have a longer lifespan than men, those  who present with T2D have a greater risk of mortality than men with diabetes.6-7

To assess how gender might play a role in the outcomes of patients with T2D and CVD (specifically atherosclerotic disease), a multi-center, multi-national collaboration of researchers from the US, Canada, European Union and New Zealand evaluated a cohort of patients who had been enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) which was a prospective, randomized, placebo controlled study.8 The researchers followed 4297 women and 10,374 men for approximately three years. The primary outcomes were CV death, myocardial infarction (MI), stroke and hospitalization for unstable angina.8

The results showed:8

  • Statistically significant results in the primary outcome of CV death, MI, stroke, or hospitalization for unstable angina which occurred in 9.7% of women and 12.3% of men (P < .0001)
  • Women also had lower risks for secondary CV risk and all-cause mortality
  • Compared to men, women were more likely to experience cerebrovascular or peripheral arterial disease
    • Men were more likely to experience coronary artery disease
  • At baseline, women were less likely to use medications for heart disease (i.e. aspirin and/or statins)

Why is this Clinically Relevant?

  • The results from this large study show that women with T2D present with worse CVD profiles but significantly fewer CV events than their male counterparts with T2D8
  • Healthcare providers should recognize that CVD and T2D are major causes of both male and female mortality, morbidity and healthcare costs
  • For all patients, encouraging lifestyle changes such as smoking cessation, diet and nutritional counseling as well as developing an exercise/activity plan are critical for improving overall health outcomes in general, CV and T2D outcomes in particular

View the abstract


  1. CDC. Heart Disease. Accessed August 6, 2018.
  2. Diabetes Statistics. Accessed August 6, 2018.
  3. Lin GM, Li YH, Lin CL, et al. Gender differences in the impact of diabetes on mortality in patients with established coronary artery disease: a report from the eastern Taiwan integrated health care delivery system of Coronary Heart Disease (ET-CHD) registry, 1997–2006. J Cardiol. 2013;61(6):393-398.
  4. Kanaya AM, Grady E, Barrett-Connor E. Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis. Arch Intern Med. 2002;162(15):1737-1745.
  5. Juutilainen A, Kortelainen S, Lehto S, et al. Gender difference in the impact of type 2 diabetes on coronary heart disease risk. Diabetes Care. 2004;27(12):2898-2904.
  6. Roche MM, Wang PP. Sex differences in all-cause and cardiovascular mortality, hospitalization for individuals with and without diabetes, and patients with diabetes diagnosed early and late. Diabetes Care. 2013;36(9):2582-2590.
  7. Barrett-Connor E, Giardina GV, GItt AK, et al. Women and heart disease: the role of diabetes and hyperglycemia. Arch Intern Med. 2004;164(9):934-942.
  8. Alfredsson J, Green JB, Stevens SR, et al. Sex differences in management and outcomes of patients with type 2 diabetes and cardiovascular disease: A report from TECOS. Diabetes Obes Metab. 2018. doi: 10.1111/dom.13377. [Epub ahead of print].


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