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More aggressive treatment recommendations for women with diabetes may be needed to reduce their risk of heart disease-related death

The presence of established coronary heart disease (CHD) in men increases their risk of death from CHD more than the presence of diabetes. But the reverse is true for women; diabetes is associated with an increased risk of death from CHD, according to a study supported by the Agency for Healthcare Research and Quality (HS10871).

Current treatment recommendations for women with diabetes may need to be more aggressive to match their CHD mortality risk, according to the study's lead author, Sundar Natarajan, M.D., M.Sc., of the Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, and the Medical University of South Carolina. Dr. Natarajan and colleagues analyzed data from the Framingham Heart Study and the Framingham Offspring Study with followup of 20 years.

At baseline (1971-1975), 134 men and 95 women had diabetes, while 222 men and 129 women had CHD. The researchers calculated the comparative effect of established CHD versus diabetes on the risk of CHD mortality after adjusting for other CHD risk factors such as age, hypertension, serum cholesterol levels, smoking, and body mass index.

Compared with men who did not have diabetes or CHD, men with only diabetes had double the risk of death from CHD, while men with only CHD had four times the risk of CHD death. Compared with women who did not have diabetes or CHD, women with only diabetes had nearly four times the risk for CHD death, and women with only CHD had nearly double the risk of CHD death. Men and women with both diabetes and CHD were at greatest risk for CHD death. The researchers urge caution in interpreting these results, since almost all participants in this community-based study were white, and these results may not hold for other populations.

See "Sex differences in risk for coronary heart disease mortality associated with diabetes and established coronary heart disease," by Dr. Natarajan, Youlian Liao, M.D., Guichan Cao, M.D., and others, in the July 28, 2003, Archives of Internal Medicine 163, pp. 1735-1740.

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