Sex differential in ischemic heart disease mortality in diabetics: a prospective population-based study

Two previous population-based US studies that examined the sex differential for heart disease mortality in diabetics showed an independent effect of diabetes on fatal heart disease only in women. This paper reports sex-specific ischemic heart disease mortality rates and relative risks for a geographically defined population in southern California of men and women aged 40-79 years, 99.5 per cent of whom were followed prospectively for seven years. When the 212 men and 131 women who had diabetes defined by personal history and/or fasting hyperglycemia were compared with 2104 nondiabetics defined by fasting euglycemia and a negative personal and family history of diabetes, the age-adjusted relative risk of death in diabetics attributed to ischemic heart disease was 2.5 for diabetic men and 3.4 for diabetic women. The sex difference increased only minimally after adjustment for heart disease risk factors when the Cox regression model was used: the adjusted risk ratio was 2.4 for diabetic men and 3.5 for diabetic women. In both men and women, diabetes, along with age and plasma cholesterol, was a statistically significant independent predictor of ischemic heart disease mortality. Among diabetics, male sex made a significant independent contribution to the prediction of fatal ischemic heart disease.