More studies required to evaluate the effect of gender on Non-Communicable diseases

Women have over 40 per cent more excess risk of serious heart conditions and after contracting diabetes than men, a major review has found. Published in Diabetologia, the study covered about 860,000 patients.

Senior Author Professor Mark Woodward, from The George Institute for Global Health and The Universities of Oxford and Sydney, said the study closely followed another, of similar size, that found that women had a conferred by diabetes than men (published in the Lancet).

“The two studies taken in conjunction show diabetes poses a greater cardiovascular hazard to women than to men,” Professor Woodward said.

Reacting to the findings of the study, Dr Vivekanand Jha of the George Institute for Global Health India, says : "The study is a wake-up call for Indian researchers to gather more sex-disaggregated statistics on the consequences of diabetes. Evidence seems to suggest that this is emerging as an international trend, but we need properly designed studies to evaluate the gender effect on non-communicable diseases which have taken center stage as the major causes of death and disability in India," says Dr Jha

While the study acknowledges the differences between men and women in cardio-vascular disease, Professor Mark Woodward says the reason for the disparity has not been confirmed.

“Our review suggests that the diabetes-related excess risk of stroke in women is due to undetected and therefore untreated higher cardiovascular risk profiles in pre diabetic condition,” said Woodward about the Lancet study. “If this is the case, then putting in place earlier detection and treatment for diabetes for women could substantially help prevent cardiovascular events.”

“It has long been speculated that women have been relatively undertreated compared to men, and that women with diabetes are more likely to have a higher cardiovascular risk. However, even when treated similarly, women are still at higher risk. This suggests that there are other factors in play.”

A more recent hypothesis was that women develop diabetes at a later stage than men, Professor Woodward said. Several studies have suggested men developed diabetes at a lower level of BMI compared with women. “For example, data from the UK Prospective Diabetes Study indicated that men with newly diagnosed diabetes were significantly less obese compared with newly-diagnosed women.”

Findings such as these, when combined with the fact that the cardiovascular burden in women is actually greater than for men, and that these differences may increase in the future due to aging populations, longer female life expectancy and delays in the development of symptomatic CVD in women relative to men highlight these areas are important for further study.

It may be necessary to develop a programme of gender-specific intervention, targeting women with increased pre-diabetic screening, combined with more stringent follow-up of women at high risk for diabetes such as women with a history of gestational diabetes, Professor Woodward said.

The World Health Organization estimates that the cardiovascular risk in people with diabetes is two to three times higher than in those without the disease, and that 50-80% of deaths in people with diabetes are caused by cardiovascular diseases. However, there is a dearth of information on women and diabetes, especially in low income countries.

"Many of these findings are of great significance for India and it is time we evolve gender sensitive approaches to address the needs and priorities of both men and women," says Dr Jha, adding : "A critical strategy must be to increase research in understanding disparities in various demographic groups including women, and to improve the availability of disaggregated data and information."