Abstract
Aims/hypothesisThe prevalence of diabetes and heart failure is increasing, and diabetes has been associated with an increased risk of heart failure. However, whether diabetes confers the same excess risk of heart failure in women and men is unknown. The aim of this study was to conduct a comprehensive systematic review with meta-analysis of possible sex differences in the excess risk of heart failure consequent to diabetes. Our null hypothesis was that there is no such sex difference.MethodsA systematic search was conducted in PubMed for population-based cohort studies published between January 1966 and November 2018. Studies were selected if they reported sex-specific estimates of RRs for heart failure associated with diabetes, and its associated variability, which were adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain pooled sex-specific RRs and women-to-men ratio of RRs (RRRs) for heart failure associated with diabetes.ResultsData from 47 cohorts, involving 12,142,998 individuals and 253,260 heart failure events, were included. The pooled multiple-adjusted RR for heart failure associated with type 1 diabetes was 5.15 (95% CI 3.43, 7.74) in women and 3.47 (2.57, 4.69) in men, leading to an RRR of 1.47 (1.44, 1.90). Corresponding pooled RRs for heart failure associated with type 2 diabetes were 1.95 (1.70, 2.22) in women and 1.74 (1.55, 1.95) in men, with a pooled RRR of 1.09 (1.05, 1.13).Conclusions/interpretationThe excess risk of heart failure associated with diabetes is significantly greater in women with diabetes than in men with diabetes.PROSPERO registration: CRD42019135246
Highlights
Diabetes and heart failure are recognised as frequent comorbid conditions; the prevalence of type 2 diabetes in individuals with heart failure was reported to be 4.3–28%, whilst that of heart failure in those with type 2 diabetes was reported to be 12–57% [1]
Of the 5991 articles identified by the systematic search, 760 articles qualified for full-text evaluation, and 14 articles provided summary data for sex differences in the association between diabetes and the risk of heart failure [5, 15–27] (Fig. 1)
The present meta-analysis, of 47 cohorts including more than 12 million individuals, showed that both type 1 and type 2 diabetes were a stronger risk factor for heart failure in women than men
Summary
Diabetes and heart failure are recognised as frequent comorbid conditions; the prevalence of type 2 diabetes in individuals with heart failure was reported to be 4.3–28%, whilst that of heart failure in those with type 2 diabetes was reported to be 12–57% [1]. Our previous metaanalyses have shown that, compared with men, women have a significantly greater excess risk of CHD [8], stroke [9], as well as the non-cardiovascular complications of dementia [10], and cancer [11], following diabetes. Whether these associations are observed for heart failure is unknown, as the previous meta-analysis on the diabetes– heart failure association [2] included single-sex studies, which may have led to unreliable results due to differences in methodology, confounding factors included and background risk between the studies of women alone and men alone. We report the most comprehensive systematic review of the literature with a meta-analysis of possible sex differences in the excess risk of heart failure consequent to diabetes using only studies that included both sexes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
