论文标题：Sex differences in the association between diabetes and risk of cardiovascular disease, cancer, and all-cause and cause-specific mortality: a systematic review and meta-analysis of 5,162,654 participants

期刊：BMC Medicine

作者：Yafeng Wang, Adrienne O’Neil, Yurui Jiao, Lijun Wang, Jingxin Huang, Yutao Lan, Yikun Zhu and Chuanhua Yu

发表时间：2019/07/12

DOI：10.1186/s12916-019-1355-0

微信链接：https://mp.weixin.qq.com/s/BQ9ljplNkDYYMIyYaC8fVg

在近期发表于BMC Medicine 上的一项新研究中，研究人员进行了系统回顾和荟萃分析，以研究糖尿病与特定原因死亡率（癌症、心血管疾病、冠心病、中风、传染病和呼吸系统疾病）和全因死亡率之间的关联的性别差异。他们发现，患有糖尿病的女性患心血管疾病和冠心病致死以及全因死亡率（尤其是后两种）的风险更高。

糖尿病是多种心脑血管疾病的主要危险因素，其并发症致残致死率高，已成为严重危害人类健康的重大公共卫生问题。在2010年，糖尿病影响全球将近4亿人群，且造成130万人死亡。随着人群中不健康生活方式和肥胖的比例增加，预计到2035年，糖尿病患者将增加到5.92亿。2型糖尿病成人发生死亡的风险比非糖尿病患者高近2倍。之前研究显示女性糖尿病患者未来发生冠心病和中风的风险比男性高，但心血管疾病以外其他疾病死亡率风险是否存在于性别差异，心血管疾病死亡风险的性别差异是多少尚不清楚。

本研究论文对49项评估糖尿病和不同死亡率结局关系的前瞻性队列研究数据进行了再分析，这些研究共涉及86个队列共5,162,654例研究对象。结局包括全因死亡率、心血管疾病死亡率、冠心病死亡率、中风死亡率、总癌症死亡率、感染性疾病死亡率和呼吸系统疾病死亡率。研究者提取了每项研究中有或无糖尿病成人的不同性别危险比（RRs），并计算了RR比值（RRRs），然后使用随机效应模型对不同研究的性别别RRs和RRRs进行再分析，并计算了其效应值及其95%置信区间（95%CI）。

该研究发现，与糖尿病相关的、全因死亡最大可获得的、校正RR的合并值女性和男性分别为1.93（95%CI：1.80-2.06）和1.74（95%CI：1.67-1.82），与男性相比，女性发生糖尿病死亡风险高出13%，合并RRR为1.13（95%CI：1.07-1.19），女性糖尿病患者发生心血管疾病死亡、冠心病死亡和中风死亡的风险分别高出30%、58%和8%。但糖尿病患者发生癌症死亡、感染性疾病死亡和呼吸系统疾病死亡风险并不存在性别差异。

糖尿病患者在血管相关疾病死亡风险上存在显著性别差异，提示在临床实践管理中应注意这一性别差异，推荐女性糖尿病患者加强体育锻炼以抵消这部分的死亡风险。此外，作者强调了将来需要进一步研究糖尿病和心血管风险之间的性别差异机制。

上述研究成果已于7月12日在BMC Medicine 在线发表，题目为 “Sex differences in the association between diabetes and risk of cardiovascular disease, cancer, and all-cause and cause-specific mortality: a systematic review and meta-analysis of 5,162,654 participants”。武汉大学健康学院宇传华教授为第一通讯作者，王亚峰博士为第一作者。

摘要：

Background

Studies have suggested sex differences in the mortality rate associated with diabetes. We conducted a meta-analysis to estimate the relative effect of diabetes on the risk of all-cause, cancer, cardiovascular disease (CVD), infectious disease, and respiratory disease mortality in women compared with men.

Methods

Studies published from their inception to April 1, 2018, identified through a systematic search of PubMed and EMBASE and review of references. We used the sex-specific RRs to derive the women-to-men ratio of RRs (RRR) and 95% CIs from each study. Subsequently, the RRR for each outcome was pooled with random-effects meta-analysis weighted by the inverse of the variances of the log RRRs.

Results

Forty-nine studies with 86 prospective cohorts met the inclusion criteria and were eligible for analysis. The pooled women-to-men RRR showed a 13% greater risk of all-cause mortality associated with diabetes in women than in men (RRR 1.13, 95% CI 1.07 to 1.19; P < 0.001). The pooled multiple-adjusted RRR indicated a 30% significantly greater excess risk of CVD mortality in women with diabetes compared with men (RRR 1.30, 95% CI 1.13 to 1.49; P < 0.001). Compared with men with diabetes, women with diabetes had a 58% greater risk of coronary heart disease (CHD) mortality, but only an 8% greater risk of stroke mortality (RRRCHD 1.58, 95% CI 1.32 to 1.90; P < 0.001; RRRstroke 1.08, 95% CI 1.01 to 1.15; P < 0.001). However, no sex differences were observed in pooled results of populations with or without diabetes for all-cancer (RRR 1.02, 95% CI 0.98 to 1.06; P = 0.21), infectious (RRR 1.13, 95% CI 0.90 to 1.38; P = 0.33), and respiratory mortality (RRR 1.08, 95% CI 0.95 to 1.23; P = 0.26).

Conclusions

Compared with men with the same condition, women with diabetes have a 58% and 13% greater risk of CHD and all-cause mortality, respectively, although there was a significant heterogeneity between studies. This points to an urgent need to develop sex- and gender-specific risk assessment strategies and therapeutic interventions that target diabetes management in the context of CHD prevention.

（来源：科学网）