Is Diabetes Equivalent to Heart Disease in Women?

Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at


If you look at the details behind the Framingham risk calculator used to predict risk of a heart attack in the next decade, those with known heart disease are specifically excluded as they are assumed to have a 20% or greater risk for recurrent event. And in case you didn't already know, >20% is considered high risk while low risk is <10%. Moderate risk is everything in between.

Of note, as I mentioned in my post last Friday, symptomatic carotid stenosis, abdominal aortic aneurysm, and peripheral artery/vascular disease are also considered coronary heart disease equivalents. But since most of the study participants were male, does this calculator really apply to women? Another analysis of the Raloxifene Use for the Heart (RUTH) was published last month in Circulation: Cardiovascular Quality Outcomes in which the authors concluded that diabetes in women is a heart disease equivalent just as it is in men.  

To arrive at their conclusion, the authors followed for over 5 years 6,937 postmenopausal women average 67 years of age and older. Those women with diabetes but without heart disease had a similar rate of death due to cardiac events as those women with heart disease but without diabetes.  So even as we attempt to personalize medicine these days, we can also apply this generalization to women as well as to men. Bottom line: regardless of medical condition, (eg diabetes vs heart disease), we need to aggressively treat all risk factors.