The impact of sex on risk of cardiovascular disease and all-cause mortality in adults with or without diabetes mellitus: A comparison between the U.S. and Japan.

Authors:
Longjian Liu
Longjian Liu
Drexel University School of Public Health
United States
Katsuyuki Miura
Katsuyuki Miura
Shiga University of Medical Science
Japan
Aya Kadota
Aya Kadota
Shiga University of Medical Science
Japan
Akira Fujiyoshi
Akira Fujiyoshi
Shiga University of Medical Science
Japan
Edward J Gracely
Edward J Gracely
Drexel University College of Medicine
United States
Fuzhong Xue
Fuzhong Xue
Shandong University
China
Zuolu Liu
Zuolu Liu
Temple University School of Medicine
Naoyuki Takashima
Naoyuki Takashima
Shiga University of Medical Science
Japan

J Diabetes Complications 2019 Jun 1;33(6):417-423. Epub 2019 Apr 1.

Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Shiga, Japan.

Aims: To test a hypothesis that women with diabetes mellitus (DM) versus those without DM had a significantly higher risk of heart disease (HD), stroke and all-cause mortality than their male counterparts in the U.S. as well as in Japan.

Methods: We analyzed two nationally representative datasets, one from the U.S. NHANES III cohort (n = 13,169), and the other from the Japan NIPPON DATA90 cohort (n = 7445). Hazard ratios (HRs) of DM for risk of mortality and sex-DM interaction effect on mortality were analyzed prospectively using Cox's proportional hazards regression models.

Results: Patients with DM had significantly higher mortality from HD, stroke and all-cause mortality in the U.S. and in Japan. However, the HRs of DM versus non-DM for HD and all-cause mortality were significantly higher in women compared to men in the U.S. (sex-DM interaction: HR = 1.59, p = 0.01, and 1.24, p = 0.045 for HD and all-cause mortality), but the sex-DM interaction effect was not statistically significant in the Japanese cohort.

Discussion: Patients with DM had a significantly higher risk of mortality than those without DM in the U.S. and Japan. However, women with DM versus those without DM had a higher relative risk of HD and all-cause mortality than their counterparts in men in the U.S, but this sex difference by DM status was not observed in the Japanese cohort. Whether the sex-difference effect of DM on HD and all-cause mortality is due to a difference in metabolic disorders between the two populations warrants consideration and further studies.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S10568727183131
Publisher Site
http://dx.doi.org/10.1016/j.jdiacomp.2019.03.008DOI Listing
June 2019
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