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Gnatiuc L, Herrington WG, Halsey J, Tuomilehto J, Fang X, Kim HC, De Bacquer D, Dobson AJ, Criqui MH, Jacobs DR, Leon DA, Peters SAE, Ueshima H, Sherliker P, Peto R, Collins R, Huxley RR, Emberson JR, Woodward M, Lewington S, Aoki N, Arima H, Arnesen E, Aromaa A, Assmann G, Bachman DL, Baigent C, Bartholomew H, Benetos A, Bengtsson C, Bennett D, Björkelund C, Blackburn H, Bonaa K, Boyle E, Broadhurst R, Carstensen J, Chambless L, Chen Z, Chew SK, Clarke R, Cox C, Curb JD, D'Agostino R, Date C, Davey Smith G, De Backer G, Dhaliwal SS, Duan XF, Ducimetiere P, Duffy S, Eliassen H, Elwood P, Empana J, Garcia-Palmieri MH, Gazes P, Giles GG, Gillis C, Goldbourt U, Gu DF, Guasch-Ferre M, Guize L, Haheim L, Hart C, Hashimoto S, Hashimoto T, Heng D, Hjermann I, Ho SC, Hobbs M, Hole D, Holme I, Horibe H, Hozawa A, Hu F, Hughes K, Iida M, Imai K, Imai Y, Iso H, Jackson R, Jamrozik K, Jee SH, Jensen G, Jiang CQ, Johansen NB, Jorgensen T, Jousilahti P, Kagaya M, Keil J, Keller J, Kim IS, Kita Y, Kitamura A, Kiyohara Y, Knekt P, Knuiman M, Kornitzer M, Kromhout D, Kronmal R, Lam TH, Law M, Lee J, Leren P, Levy D, Li YH, Lissner L, Luepker R, Luszcz M, MacMahon S, Maegawa H, Marmot M, Matsutani Y, Meade T, Morris J, Morris R, Murayama T, Naito Y, Nakachi K, Nakamura M, Nakayama T, Neaton J, Nietert PJ, Nishimoto Y, Norton R, Nozaki A, Ohkubo T, Okayama A, Pan WH, Puska P, Qizilbash N, Reunanen A, Rimm E, Rodgers A, Saitoh S, Sakata K, Sato S, Schnohr P, Schulte H, Selmer R, Sharp D, Shifu X, Shimamoto K, Shipley M, Silbershatz H, Sorlie P, Sritara P, Suh I, Sutherland SE, Sweetnam P, Tamakoshi A, Tanaka H, Thomsen T, Tominaga S, Tomita M, Törnberg S, Tunstall-Pedoe H, Tverdal A, Ueshima H, Vartiainen E, Wald N, Wannamethee SG, Welborn TA, Whincup P, Whitlock G, Willett W, Woo J, Wu ZL, Yao SX, Yarnell J, Yokoyama T, Yoshiike N, Zhang XH. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol 2018; 6:538-546. [PMID: 29752194 PMCID: PMC6008496 DOI: 10.1016/s2213-8587(18)30079-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men. METHODS In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes. RESULTS Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes. INTERPRETATION Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).
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Shickle D, Carlisle J, Fryers P, Wallace S, Suckling R, Cork M, Bowns I, Beyleveld D, McDonagh A, Sandvik L, Mowinckel P, Abdelnoor M, Erikssen G, Erikssen J, White R, Altmann DR, Nanchahal K, Oliver S, Donovan JL, Peters TJ, Frankel S, Hamdy FC, Neal DE, Whincup PH, Gilg J, Papacosta O, Miller GJ, Alberti KGMM, Cook D, Lawlor DA, Ebrahim S, Smith GD, Lampe F, Morris R, Whincup P, Walker M, Ebrahim S, Shaper A, Brunner E, Shipley M, Hemingway H, Juneja M, Page M, Stansfeld S, Kumari M, Walker B, Andrew R, Seckl J, Papadopoulos A, Checkley S, Marmot M, Wood D, Sheehan J, Reilly M, Twomey H, Collins M, Daly A, Loningsigh S, Dolan E, Smith GD, Ben-Shlomo Y, Perry I, Moher M, Yudkkin P, Wright L, Turner R, Fuller A, Schofield T, Mant D, Feder G, Lilford RJ, Dobbie F, Warren R, Braunholtz D, Boaden R, Nolte E, Scholz R, Shkolnikov V, McKee M, Neilson S, Gilthorpe MS, Wilson RC, Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T, Cromwell DA, Griffiths DA, Campbell MJ, Mollison J, McIntosh E, Grimshaw J, Thomas R, Rovers MM, Straatman H, Zielhuis GA, Hemminki E, Hove SL, Veerus P, Hakama M, Tuimala R, Rahu M, Ukoumunne OC, Gulliford MC, Shepstone L, Spencer N, Araya R, Rojas G, Fritsch RE, Acuna J, Lewis G, Ajdacic-Gross V, Bopp M, Eich D, Rossler W, Gutzwiller F, Corcoran P, Brennan A, Reilly M, Perry IJ, Middleton N, Whitley E, Frankel S, Dorling D, Gunnell D, Stanistreet D, Paine K, Scherf C, Morison L, Walraven G, O'Cathain A, Sampson F, Nicholl J, Munro J, Chapple A, Ziebland S, McPherson A, Herxheimer A, Shepperd S, Miller R, Brindle L, Donovan JL, Peters TJ, Quine S, O'Reilly M, Cahill M, Perry IJ, Maconochie N, Doyle P, Prior S, Ego A, Subtil D, Cosson M, Legoueff F, Houfflin-Debarge V, Querleu D, Rasmussen F, Smith GD, Sterne JAC, Tynelius P, Leon DA, Doyle P, Roman E, Maconochie N, Smith P, Beral V, Macfarlane A, Shoham-Vardi I, Winer N, Weitzman D, Levcovich A, Lahelma E, Kivela K, Roos E, Tuominen T, Dahl E, Diderichsen F, Elstad J, Lissau I, Lundberg O, Rahkonen O, Rasmussen NK, Yngwe MA, Gilmore AB, McKee M, Rose R, Salmond C, Crampton P, Tobias M, Li L, Manor O, Power C, Bruster S, Coulter A, Jenkinson C, Osler M, Prescott E, Gronbak M, Andersen AN, Due P, Engholm G, Drury N, Bruce J, Poobalan AS, Smith WCS, Jeffrey RR, Chambers WA, Mueller JE, Doring A, Stieber J, Thorand B, Lowel H, Chen R, Tunstall-Pedoe H, Redpath A, Macintyre K, Stewart S, Chalmers JWT, Boyd AJ, Finlayson A, Pell JP, McMurray JJV, Capewell S, Chalmers JWT, Macintyre K, Stewart S, Boyd AJ, Finlayson A, Pell JP, Redpath, McMurray JJV, Capewell S, Critchley J, Capewell S, Stefoski-Mikeljevic J, Johnston C, Cartman M, Sainsbury R, Forman D, Haward R, Morris E, Haward R, Forman D, Cartman M, Johnston C, Moebus S, Lehmann N, Goodacre S, Calvert N, Montgomery AA, Fahey T, Ben-Shlomo Y, Harding J, Anderson W, Florin D, Gillam S, Ely M, Nath U, Ben-Shlomo Y, Thomson RG, Morris HR, Wood NW, Lees AJ, Burn DJ, West RR, Fielder HM, Palmer SR, Dunstan F, Fone D, Higgs G, Senior M, Moss N, Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, Donovan J, Rottingen JA, Garnett GP, Jagger C, Robine JM, Clarke M, Tobiasz-Adamczyk B, Szafraniec K, Lall R, Campbell MJ, Walter SJ, McGrother C, Donaldson M, Dallosso H, Dineen BP, Bourne RR, Ali SM, Huq DMN, Johnson GJ, Stang A, Jockel KH, Karvonen S, Vikat A, Rimpela M, Borras JM, Schiaffino A, Fernandez E, Borrell C, Garcia M, Salto E, Jefferis B, Power C, Graham H, Manor O, Yudkin P, Hey K, Roberts S, Welch S, Johnstone E, Murphy M, Griffiths S, Jones L, Walton R, Rasul F, Stansfeld SA, Hart CL, Gillis C, Smith GD, Marks D, Lambert H, Thorogood M, Neil H, Humphries S, Wonderling D, Surman G, Newdick H, Johnson A, Pharoah P, Glinianaia SV, Wright C, Rankin J, Basso O, Christensen K, Olsen J, Love A, Cheung WY, Williams J, Jackson S, Maddocks A, Hutchings H, Gissler M, Pakkanen M, Olausson PO, Owen CG, Whincup PH, Odoki K, Gilg JA, Cook DG, Aveyard P, Markham WA, Sherratt E, Bullock A, Macarthur C, Cheng KK, Daniels H, Murphy S, Egger M, Grimsley M, Green G, Read C, Redgrave P, Suokas A, McCulloch A, Zagozdzon P, Zaborski L, Cardano M, Costa G, Demaria M, Gnavi R, Spadea T, Vannoni F, Batty D, Leon DA, Rahi J, Morton S, Leon D, Stavola BDE, Gunnell D, Fouskakis D, Rasmussen F, Tynelius P, Harrison G, Spadea T, Faggiano F, Armaroli P, Maina L, Costa G, Ellison GTH, Travis R, Phillips M, Dedman D, Upton M, McCarthy A, Elwood P, Davies D, Shlomo YB, Smith GD, Berrington A, Cramer DW, Kuper H, Harlow BL, Titus-Ernstoff L, McLeod A, Stockton D, Brown H, Leyland AH, Liratsopulos G, West CR, Williams EMI, Abrams K, Sharp L, Little J, Brockton N, Cotton SC, Haites NE, Cassidy J, Kamali A, Kinsman J, Kintu P, Quigley M, Carpenter L, Kengeya-Kayondo J, Whitworth. JAG, Porter K, Noah N, Rawson H, Crampin A, Smith WCS, Group CMSOBOTMS, Jahn A, Kudzala A, Kitundu H, Lyamuya E, Razum O, Thomas SL, Wheeler JG, Hall AJ, Moore L, Dennehy A, Shemilt I, Belderson P, Brandon M, Harvey I, Moffatt P, Mugford M, Norris N, O'Brien M, Reading R, Robinson J, Schofield G, Shepstone L, Thoburn J, Cliffe S, Leiva A, Tookey P, Hamers F, Nicoll A, Critchley J, Capewell S, Ness AR, Hughes J, Elwood PC, Whitley E, Smith GD, Burr ML, Chase D, Roderick P, Cooper K, Davies R, Raftery J, Martikainen P, Kauppinen TM, Valkonen T, Somerville M, Barton A, Foy C, Basham M, Thomson H, Petticrew M, Morrison D, Chandola T, Biddulph J, McCarthy M, Gallivan S, Utley M, Kinra S, Black ME, Murphy M, Hey K, Jones L, Brzezinski ZJ, Mazur J, Mierzejewska E, Evans JG, Clarke R, Sherliker P, Birks J, Wrieden WL, Connaghan JP, Tunstall-Pedoe H, Silva IDS, Mangtani P, McCormack V, Bhakta D, Sevak L, McMichael AJ, Sauvaget C, Nagano J, Ogilvie D, Raffle AE, Alden B, Brett M, Babb PJ, Quinn 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J, Herzig P, Giani G, Olowokure B, Spencer NJ, Hawker JI, Blair I, Smith R, Olowokure B, White J, Rush M, Hawker JI, Ramsay M, Watkins J, Mayor S, Matthews I, Crilly M, Bundred P, Prosser H, Walley T, Walker ZAK, Oakley L, Townsend JL, Donovan C, Smith H, Bell J, Hurst Z, Marshall S, Wild S, Whyman C, Barter M, Wishart K, Macleod C, Marinko K, Malmstrom M, Johansson SE, Sundquist J, Crampton P, Salmond C, Tobias M, Lumley J, Small R, Brown S, Watson L, Gunn J, Hawe P, Shiell A, Langer M, Steiner G, Tiefenthaler M, Adamek S, Ronsmans C, Khlat M, Waterstone M, Bewley S, Wolfe C, Hooper R, Moore L, Campbell R, Whelan A, Winter H, Macarthur C, Bick D, Lancashire R, Knowles H, Henderson C, Belfield C, Gee H, Biggerstaff D, Lilford R, Olsen J, the EuroMap Group, Spencer EA, Davey GK, Appleby PN, Key TJ., Breeze E, Leon D, Clarke R, Fletcher A, Boniface DR, McNeilly E, Lam TH, Ho SY, Hedley AJ, Mak KH, Canoy D, Khaw KT, Thorogood M, Appleby PN, Mann JI, Key TJ, Bobak M, Pikhart H, Martikainen P, Rose R, Marmot M, Rooney CIF, Cook L, Uren Z, Watson MC, Bond CM, Grimshaw JM, Mollison J, Ludbrook A, Poobalan AS, Bruce J, King PM, Krukowksi ZH, Smith WCS, Chambers WA, Seagroatt V, Goldacre M, Purcell B, Majeed A, Mayor S, Watkins J, Matthews I, Morris RW, Whincup PH, Emberson J, Lampe FC, Walker M, Wannamethee G, Shaper AG, Ebrahim S, May M, McCarron P, Frankel S, Smith GD, Yarnell J, Ebrahim S, May M, McCarron P, Shlomo YB, Stansfeld S, Gallacher J, Smith GD, Taylor FC, Rees K, Ebrahim S, Angelini GD, Ascione R, Muller-Nordhorn J, Binting S, Kulig M, Voller H, Willich SN, Group FTPS, Whincup PH, Emberson J, Papacosta O, Walker M, Lennon L, Thomson A, Sturdy PM, Anderson HR, Butland BK, Bland JM, Victor CR, Wilman C, Gupta R, Anderson HR, Mindell J, Joffe M, Nikiforov B, Pattenden S, Armstrong B, Hedley AJ, Wong CM, Thach TQ, Chau P, Lam TH, Anderson HR, Whitley E, Darby S, Deo H, Doll R, Raleigh VS, Logie J, Macrae K, Lawrenson R, Villegas R, Nielson S, O'Halloran DJ, Perry 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Allen NE, Key TJ, Vatten LJ, Odegard RA, Nilsen ST, Austgulen R, Harding AH, Khaw KT, Wareham NJ, Riza E, Silva IDS, De Stavola B, Bradlow HL, Sepkovic DW, Linos D, Linos A. Society for Social Medicine and the International Epidemiological Association European Group. Abstracts of oral presentations. Br J Soc Med 2001. [DOI: 10.1136/jech.55.suppl_1.a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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