Abstract
Aims: To test a hypothesis that women with diabetes mellitus (DM)versus those without DM had a significantly higher risk of heart disease (HD), stroke and all-cause mortality than their male counterparts in the U.S. as well as in Japan. Methods: We analyzed two nationally representative datasets, one from the U.S. NHANES III cohort (n = 13,169), and the other from the Japan NIPPON DATA90 cohort (n = 7445). Hazard ratios (HRs)of DM for risk of mortality and sex-DM interaction effect on mortality were analyzed prospectively using Cox's proportional hazards regression models. Results: Patients with DM had significantly higher mortality from HD, stroke and all-cause mortality in the U.S. and in Japan. However, the HRs of DM versus non-DM for HD and all-cause mortality were significantly higher in women compared to men in the U.S. (sex-DM interaction: HR = 1.59, p = 0.01, and 1.24, p = 0.045 for HD and all-cause mortality), but the sex-DM interaction effect was not statistically significant in the Japanese cohort. Discussion: Patients with DM had a significantly higher risk of mortality than those without DM in the U.S. and Japan. However, women with DM versus those without DM had a higher relative risk of HD and all-cause mortality than their counterparts in men in the U.S, but this sex difference by DM status was not observed in the Japanese cohort. Whether the sex-difference effect of DM on HD and all-cause mortality is due to a difference in metabolic disorders between the two populations warrants consideration and further studies.
| Original language | English |
|---|---|
| Pages (from-to) | 417-423 |
| Number of pages | 7 |
| Journal | Journal of Diabetes and its Complications |
| Volume | 33 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 2019 Jun |
Keywords
- CVD
- Diabetes mellitus
- US-Japan comparison
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Endocrinology
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The impact of sex on risk of cardiovascular disease and all-cause mortality in adults with or without diabetes mellitus : A comparison between the U.S. and Japan. / Liu, Longjian; Miura, Katsuyuki; Kadota, Aya; Fujiyoshi, Akira; Gracely, Edward J.; Xue, Fuzhong; Liu, Zuolu; Takashima, Naoyuki; Miyagawa, Naoko; Ohkubo, Takayoshi; Arima, Hisatomi; Okayama, Akira; Okamura, Tomonori; Ueshima, Hirotsugu.
In: Journal of Diabetes and its Complications, Vol. 33, No. 6, 06.2019, p. 417-423.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - The impact of sex on risk of cardiovascular disease and all-cause mortality in adults with or without diabetes mellitus
T2 - A comparison between the U.S. and Japan
AU - Liu, Longjian
AU - Miura, Katsuyuki
AU - Kadota, Aya
AU - Fujiyoshi, Akira
AU - Gracely, Edward J.
AU - Xue, Fuzhong
AU - Liu, Zuolu
AU - Takashima, Naoyuki
AU - Miyagawa, Naoko
AU - Ohkubo, Takayoshi
AU - Arima, Hisatomi
AU - Okayama, Akira
AU - Okamura, Tomonori
AU - Ueshima, Hirotsugu
N1 - Funding Information: The study used data from NHANES III, conducted by the U.S. National Center for Health Statistics (NCHS), and data from Japan NIPPON DATA80/90 that were supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare under the auspices of the Japanese Association for Cerebro-cardiovascular Disease Control, a Research Grant for Cardiovascular Diseases (7A-2) from the Ministry of Health, Labour and Welfare , and Health and Labour Sciences Research Grants, Japan (Comprehensive Research on Aging and Health [H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014] and Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus [H22-Junkankitou-Seishuu -Sitei-017, H25-Junkankitou-Seishuu-Sitei-022, H30-Junkankitou-Sitei-002]). Our thanks go to the NCHS and NIPPON DATA80/90 Committee for the availabilities to use the datasets (a list of the NIPPON DATA80/90 research group is shown in the Supplementary data). Findings and conclusions in this report are those of the authors and do not necessarily reflect the views or opinions of the U.S. NCHS or the Ministry of Health, Labour and Welfare of Japan. Funding Information: NIPPON DATA, supported by the Ministry of Health and Welfare of Japan, included two independent cohorts of Japanese aged ?30 at baseline who were enrolled in 1980 and 1990 separately, called NIPPON DATA80 (n?=?10,897)and NIPPON DATA90 (n?=?8926). Participants in both NIPPON DATA80 and NIPPON DATA90 were randomly selected from 300 districts across Japan. The two cohorts consisted of physical examinations, blood tests, and a self-administered questionnaire on lifestyle. Mortality follow-ups were conducted for all participants of NIPPON DATA80 and NIPPON DATA90.18,20,21 Participants in NIPPON DATA90 were followed until November 2010. The mean (SD)and median follow-up periods were 17.84 (4.62)and 20?years. We used NIPPON DATA90 in the present study because it was conducted approximately in the same period (1990?2010)and had the same measures of biomarkers as the U.S. NHANES III (1988?2011). Furthermore, Lipid measurements in NIPPON DATA90 were standardized by the U.S. CDC/NHLBI (Centers for Disease Control and Prevention/National Heart, Lung, and Blood Institute)Lipids Standardization Program,22 which ensured the comparability between the two datasets. In NIPPON DATA90, of 8383 baseline participants aged ?30, we excluded 284 subjects who had invalid follow-up data and excluded 654 subjects who had missing values on DM status. There remained 7445 (88.8% of 8383)for the analysis (M: 3128, W: 4317), Fig. 1. The present analysis and dataset obtained from the NIPPON DATA Steering Committee have been approved by the IRB of the Shiga University of Medical Science.4,18,23,24The study used data from NHANES III, conducted by the U.S. National Center for Health Statistics (NCHS), and data from Japan NIPPON DATA80/90 that were supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare under the auspices of the Japanese Association for Cerebro-cardiovascular Disease Control, a Research Grant for Cardiovascular Diseases (7A-2)from the Ministry of Health, Labour and Welfare, and Health and Labour Sciences Research Grants, Japan (Comprehensive Research on Aging and Health [H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014]and Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus [H22-Junkankitou-Seishuu -Sitei-017, H25-Junkankitou-Seishuu-Sitei-022, H30-Junkankitou-Sitei-002]). Our thanks go to the NCHS and NIPPON DATA80/90 Committee for the availabilities to use the datasets (a list of the NIPPON DATA80/90 research group is shown in the Supplementary data). Findings and conclusions in this report are those of the authors and do not necessarily reflect the views or opinions of the U.S. NCHS or the Ministry of Health, Labour and Welfare of Japan. The study used data from NHANES III, conducted by the U.S. National Center for Health Statistics (NCHS), and data from Japan NIPPON DATA80/90 that were supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare under the auspices of the Japanese Association for Cerebro-cardiovascular Disease Control, a Research Grant for Cardiovascular Diseases (7A-2)from the Ministry of Health, Labour and Welfare, and Health and Labour Sciences Research Grants, Japan (Comprehensive Research on Aging and Health [H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014]and Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus [H22-Junkankitou-Seishuu -Sitei-017, H25-Junkankitou-Seishuu-Sitei-022, H30-Junkankitou-Sitei-002]). Our thanks go to the NCHS and NIPPON DATA80/90 Committee for the availabilities to use the datasets (a list of the NIPPON DATA80/90 research group is shown in the Supplementary data). Findings and conclusions in this report are those of the authors and do not necessarily reflect the views or opinions of the U.S. NCHS or the Ministry of Health, Labour and Welfare of Japan. None reported. Funding Information: NIPPON DATA, supported by the Ministry of Health and Welfare of Japan, included two independent cohorts of Japanese aged ≥30 at baseline who were enrolled in 1980 and 1990 separately, called NIPPON DATA80 (n = 10,897) and NIPPON DATA90 (n = 8926). Participants in both NIPPON DATA80 and NIPPON DATA90 were randomly selected from 300 districts across Japan. The two cohorts consisted of physical examinations, blood tests, and a self-administered questionnaire on lifestyle. Mortality follow-ups were conducted for all participants of NIPPON DATA80 and NIPPON DATA90.18,20,21 Participants in NIPPON DATA90 were followed until November 2010. The mean (SD) and median follow-up periods were 17.84 (4.62) and 20 years. We used NIPPON DATA90 in the present study because it was conducted approximately in the same period (1990–2010) and had the same measures of biomarkers as the U.S. NHANES III (1988–2011). Furthermore, Lipid measurements in NIPPON DATA90 were standardized by the U.S. CDC/NHLBI (Centers for Disease Control and Prevention/National Heart, Lung, and Blood Institute) Lipids Standardization Program,22 which ensured the comparability between the two datasets. In NIPPON DATA90, of 8383 baseline participants aged ≥30, we excluded 284 subjects who had invalid follow-up data and excluded 654 subjects who had missing values on DM status. There remained 7445 (88.8% of 8383) for the analysis (M: 3128, W: 4317), Fig. 1. The present analysis and dataset obtained from the NIPPON DATA Steering Committee have been approved by the IRB of the Shiga University of Medical Science.4,18,23,24The study used data from NHANES III, conducted by the U.S. National Center for Health Statistics (NCHS), and data from Japan NIPPON DATA80/90 that were supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare under the auspices of the Japanese Association for Cerebro-cardiovascular Disease Control, a Research Grant for Cardiovascular Diseases (7A-2) from the Ministry of Health, Labour and Welfare, and Health and Labour Sciences Research Grants, Japan (Comprehensive Research on Aging and Health [H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014] and Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus [H22-Junkankitou-Seishuu -Sitei-017, H25-Junkankitou-Seishuu-Sitei-022, H30-Junkankitou-Sitei-002]). Our thanks go to the NCHS and NIPPON DATA80/90 Committee for the availabilities to use the datasets (a list of the NIPPON DATA80/90 research group is shown in the Supplementary data). Findings and conclusions in this report are those of the authors and do not necessarily reflect the views or opinions of the U.S. NCHS or the Ministry of Health, Labour and Welfare of Japan. The study used data from NHANES III, conducted by the U.S. National Center for Health Statistics (NCHS), and data from Japan NIPPON DATA80/90 that were supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare under the auspices of the Japanese Association for Cerebro-cardiovascular Disease Control, a Research Grant for Cardiovascular Diseases (7A-2) from the Ministry of Health, Labour and Welfare, and Health and Labour Sciences Research Grants, Japan (Comprehensive Research on Aging and Health [H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014] and Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus [H22-Junkankitou-Seishuu -Sitei-017, H25-Junkankitou-Seishuu-Sitei-022, H30-Junkankitou-Sitei-002]). Our thanks go to the NCHS and NIPPON DATA80/90 Committee for the availabilities to use the datasets (a list of the NIPPON DATA80/90 research group is shown in the Supplementary data). Findings and conclusions in this report are those of the authors and do not necessarily reflect the views or opinions of the U.S. NCHS or the Ministry of Health, Labour and Welfare of Japan. None reported. Funding Information: The study used data from NHANES III, conducted by the U.S. National Center for Health Statistics (NCHS), and data from Japan NIPPON DATA80/90 that were supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare under the auspices of the Japanese Association for Cerebro-cardiovascular Disease Control, a Research Grant for Cardiovascular Diseases (7A-2) from the Ministry of Health, Labour and Welfare , and Health and Labour Sciences Research Grants, Japan (Comprehensive Research on Aging and Health [H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014] and Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus [H22-Junkankitou-Seishuu -Sitei-017, H25-Junkankitou-Seishuu-Sitei-022, H30-Junkankitou-Sitei-002]). Our thanks go to the NCHS and NIPPON DATA80/90 Committee for the availabilities to use the datasets (a list of the NIPPON DATA80/90 research group is shown in the Supplementary data ). Findings and conclusions in this report are those of the authors and do not necessarily reflect the views or opinions of the U.S. NCHS or the Ministry of Health, Labour and Welfare of Japan. Publisher Copyright: © 2019 Elsevier Inc.
PY - 2019/6
Y1 - 2019/6
N2 - Aims: To test a hypothesis that women with diabetes mellitus (DM)versus those without DM had a significantly higher risk of heart disease (HD), stroke and all-cause mortality than their male counterparts in the U.S. as well as in Japan. Methods: We analyzed two nationally representative datasets, one from the U.S. NHANES III cohort (n = 13,169), and the other from the Japan NIPPON DATA90 cohort (n = 7445). Hazard ratios (HRs)of DM for risk of mortality and sex-DM interaction effect on mortality were analyzed prospectively using Cox's proportional hazards regression models. Results: Patients with DM had significantly higher mortality from HD, stroke and all-cause mortality in the U.S. and in Japan. However, the HRs of DM versus non-DM for HD and all-cause mortality were significantly higher in women compared to men in the U.S. (sex-DM interaction: HR = 1.59, p = 0.01, and 1.24, p = 0.045 for HD and all-cause mortality), but the sex-DM interaction effect was not statistically significant in the Japanese cohort. Discussion: Patients with DM had a significantly higher risk of mortality than those without DM in the U.S. and Japan. However, women with DM versus those without DM had a higher relative risk of HD and all-cause mortality than their counterparts in men in the U.S, but this sex difference by DM status was not observed in the Japanese cohort. Whether the sex-difference effect of DM on HD and all-cause mortality is due to a difference in metabolic disorders between the two populations warrants consideration and further studies.
AB - Aims: To test a hypothesis that women with diabetes mellitus (DM)versus those without DM had a significantly higher risk of heart disease (HD), stroke and all-cause mortality than their male counterparts in the U.S. as well as in Japan. Methods: We analyzed two nationally representative datasets, one from the U.S. NHANES III cohort (n = 13,169), and the other from the Japan NIPPON DATA90 cohort (n = 7445). Hazard ratios (HRs)of DM for risk of mortality and sex-DM interaction effect on mortality were analyzed prospectively using Cox's proportional hazards regression models. Results: Patients with DM had significantly higher mortality from HD, stroke and all-cause mortality in the U.S. and in Japan. However, the HRs of DM versus non-DM for HD and all-cause mortality were significantly higher in women compared to men in the U.S. (sex-DM interaction: HR = 1.59, p = 0.01, and 1.24, p = 0.045 for HD and all-cause mortality), but the sex-DM interaction effect was not statistically significant in the Japanese cohort. Discussion: Patients with DM had a significantly higher risk of mortality than those without DM in the U.S. and Japan. However, women with DM versus those without DM had a higher relative risk of HD and all-cause mortality than their counterparts in men in the U.S, but this sex difference by DM status was not observed in the Japanese cohort. Whether the sex-difference effect of DM on HD and all-cause mortality is due to a difference in metabolic disorders between the two populations warrants consideration and further studies.
KW - CVD
KW - Diabetes mellitus
KW - US-Japan comparison
UR - http://www.scopus.com/inward/record.url?scp=85064270202&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064270202&partnerID=8YFLogxK
U2 - 10.1016/j.jdiacomp.2019.03.008
DO - 10.1016/j.jdiacomp.2019.03.008
M3 - Article
C2 - 31003923
AN - SCOPUS:85064270202
VL - 33
SP - 417
EP - 423
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
SN - 1056-8727
IS - 6
ER -