More than 30 million Americans live with diabetes, making it the seventh leading cause of death in the United States, according to the American Diabetes Association. And it’s well documented that people with diabetes are at increased risk of developing heart failure (HF). But experts didn’t know how important a role gender plays in people with diabetes developing HF until now.
According to a study published in May 2019 in Diabetologia (the journal of the European Association for the Study of Diabetes) that compared roughly 12 million men and women, women with type 1 diabetes had a 47 percent higher risk of heart failure compared with men with type 1 diabetes. Women with type 2 diabetes had a 9 percent higher risk of developing the condition than men with type 2 diabetes.
“The increased risk of heart failure following a diabetes diagnosis is significantly greater in women than men, which highlights the importance of intensive prevention and treatment of diabetes in women,” says the lead author, Toshiaki Ohkuma, PhD, a research fellow at the George Institute for Global Health in Newtown, Australia.
The reason for the difference is unclear, but researchers have a few theories.
The prediabetes period, the time when blood sugar levels are elevated but you may not have symptoms or be diagnosed with diabetes yet, can be longer in women by as much as two years, which may be associated with a greater excess risk of HF.
Also, heart attack symptoms in women are not well established and often go untreated, which may also correspond to an increased likelihood of HF in this population. “As the symptoms for women with a heart attack are less well known than the symptoms for men, many more women suffer from ‘silent heart attacks.’ They are not receiving treatment with silent heart attacks and the second heart attack is often more severe than the first,” says Robert Busch, MD, an endocrinologist and the director of clinical research at the Albany Medical Center in New York, who was not involved in the study.
Study authors also note that “sex differences in diabetes management could underpin these associations, as historically women have had poorer blood sugar control than men.”
“Further research is required to understand the mechanisms underpinning the excess risk of heart failure conferred by diabetes [particularly type 1] in women and to reduce the burden associated with diabetes in both sexes,” says Dr. Ohkuma.
