Diabetes-associated stroke risk higher in women: study

By Megan Brooks

NEW YORK (Reuters Health) - The excess risk of stroke associated with diabetes is far higher in women than in men, a systematic review and meta-analysis finds.

"Compared with men with diabetes, women with diabetes should have their cardiovascular risk factors treated more aggressively so as to minimize the excess risk of stroke, and coronary heart disease that occurs in these women," advised Rachel Huxley of University of Queensland, Australia, in email to Reuters Health.

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In a 2006 paper in BMJ, Huxley and colleagues showed that the relative risk of diabetes-related coronary heart disease is substantially higher in women than in men.

To see if this sex difference also exists for stroke, Huxley and colleagues analyzed data from 64 cohort studies, including 775,385 individuals and 12,539 fatal and nonfatal stroke events.

The pooled maximum-adjusted relative risk of stroke associated with diabetes was 2.28 in women and 1.83 in men, and the pooled ratio of relative risks between women and men was 1.27, with no evidence of publication bias, the researchers reported online March 7 in the Lancet.

Diabetic women also had greater risk of suffering fatal stroke (RR 2.29) than men (RR 1.74), with corresponding ratio of RRs (women to men) of 1.32.

The sex disparity in the risk of stroke related to diabetes was seen across a wide range of prespecified subgroups and held up in several sensitivity analyses, the researchers say.

"This study not only provides convincing evidence that women with diabetes have a higher risk of stroke than their male counterparts, but also confirms the previous finding that women with diabetes have poorer survival after stroke than men," writes Linong Ji, of Peking University People's Hospital, Beijing, China, in a Comment published with the study.

"This finding warrants further research to explore the causes of the sex difference in order to improve medical care for women with diabetes," Dr. Ji says.

"Some conditions specific to women, such as pregnancy, pre-eclampsia, gestational diabetes, use of oral contraceptives, and use of hormone treatments are associated with increased risk of stroke, and some conditions such as migraine with aura, atrial fibrillation, hypertension, depression, and psychosocial stress can be more prevalent in women than in men. Whether such risk factors confer the same risk of stroke in women and men remains to be investigated," Dr. Ji concludes.

SOURCES: http://bit.ly/1qdtW8U and http://bit.ly/1hMRtHD

Lancet 2014.

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