A lack of sex-specific data from early epidemiological studies has typically led to the assumption that the associations between risk factors and disease outcomes are equivalent in women as in men. But increasingly, evidence to support the existence of clinically meaningful sex differences in the relationships between certain risk factors, such as smoking and diabetes with chronic disease is becoming apparent – often to the detriment of women. Determining reliably whether there are clinically meaningful sex-differences in risk factor-disease associations is important, not solely to better understand the aetiology of CVD, but also from a population and public health vantage. Current estimates of the burden of CVD, that are used to inform public health policy, assume that these risk factors effect cardiovascular risk similarly in women as in men. However, if this assumption is proven to be invalid then it would necessitate the revision of the estimates to more accurately reflect the true nature of the relationships in women and men. Moreover, just as possible racial differences in the relationships between risk factors and diseases are considered when tailoring specific interventions for different communities, so could information on important sex differences be used to provide an added impetus for targeted interventions aimed at the treatment and management of these risk factors in both sexes.

Recently we have conducted two systematic reviews and meta-analyses of the sex-specific effects of diabetes on risk of stroke and coronary heart disease. Both studies suggested that women with diabetes had a substantially greater excess risk compared with their male equivalents, even after consideration of differences in baseline levels of other major risk factors. In this talk, the results from these studies will be presented, potential biological, behavioral, or social mechanisms involved will be discussed, clinical implications will be considered, and directions for future research will be provided.