Sex Differences in Cardiovascular Complications of Type 2 Diabetes

The estimated global prevalence of diabetes is similar for women and men (8.4% vs. 8.9%). Even among people with type 2 diabetes (T2D), there are known gender differences in the impact of the disease. The relative risk of cardiovascular (CV) complications between people with and without T2D is higher in women than in men. In contrast, lifestyle interventions and bariatric surgery appear to have similar effects regardless of gender. Importantly, not only is the excess risk of coronary artery disease associated disproportionately highly with diabetes, but the clinical presentation of coronary artery disease differs between women and men. Women more often present with atypical symptoms of angina, which can hinder accurate diagnosis and early treatment, potentially leading to disease progression and subsequent myocardial infarction. Whether these gender differences also exist in CV disease remains uncertain. Evidence that men and women experience diabetes-related conditions differently suggests that further research is needed to clarify the biological, behavioral, or social mechanisms involved. Meanwhile, the menopausal transition in women is a time of accelerated cardiovascular disease risk. Endocrine and metabolic changes are closely linked during the menopausal transition. This review highlights key differences in diabetes-related CV complications by gender.