Читать книгу Diabetic Retinopathy and Cardiovascular Disease - Группа авторов - Страница 17

Despite diabetes being a strong independent risk factor for cardiovascular disease, the degree of risk inferred by the presence of diabetes is not the same in all groups. Interestingly, the relative risk associated with diabetes is greater in groups with lower absolute cardiovascular risk, including among women, younger age groups, non-smokers and those with lower-than-average blood pressure [4]. A meta-analysis of 64 cohorts, including more than 850,000 individuals found that the effect of diabetes on the risk of incident coronary heart disease was 44% greater in women than in men, though the absolute risk remains higher in men [25]. This difference in the risk posed by diabetes may in part relate to the inequitable management of cardiometabolic disease in women. There is evidence that women are less likely than men to be treated sufficiently to meet target risk factor levels [26]. Nevertheless, in more recent studies, where treatment was felt to be equitable, there is still evidence of a disparity in the relative risk of cardiovascular disease inferred by diabetes [25]. At the time of diagnosis of diabetes, women tend to have greater adiposity and less favourable levels of other cardiovascular risk factors. It is thought that women may tend to have a greater deterioration in their overall cardiometabolic health prior to having sufficient hyperglycaemia to be diagnosed as having diabetes. Along with treatment inequalities, these physiological differences may also contribute to the observed differences in relative risk of cardiovascular disease between men and women with diabetes. It may also be that the relative effect of diabetes (or any other single cardiovascular risk factor) is greater in low-risk groups than high-risk groups (as noted above), and that this simply reflects that many risk factors have overlapping mechanistic pathways. Thus, adding the first or second risk factor to low-risk groups will have more of an effect than adding the fourth or fifth risk factor to high-risk groups.