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Men and women, diabetes and heart disease

Everyone learns in medical school that men are at higher risk for death from heart attacks than women, and that fact is commonly repeated in journal articles. It is also commonly repeated that diabetes increases the risk for heart disease, and that diabetes is a stronger risk factor for heart disease in women than it is in men. Generally accepted statements like these always deserve a closer look, and somewhat surprisingly this American Heart Association Scientific Statement, just released today, provides some interesting insight into these questions. I say surprisingly, because these types of statements and guidelines are often, to my mind, biased by the composition of the panel members, who are mostly older gray-haired white men (like myself), but who typically (over 75%) have numerous ties to industry (unlike myself). In a stunning and totally practical turnaround, this panel consisted entirely of women, and I think related to this, there were almost no ties to pharmaceutical companies. Figure 2 from this report, shown below, is quite striking. Note that the female advantage in heart disease is present only

in white women, and that Hispanic individuals, as has been reported in other studies, have significantly less heart disease than Whites and Blacks (to follow their terminology). This report also reveals that although diabetes causes more of a relative risk increase in women than men, that white women with diabetes still have less heart disease than their male counterparts. Sweeping statements about risk are attractive for marketing and public health statements, but can hide more informative information.

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