For coronary heart disease, the protective effect of female sex is lost. Diabetes is an equal opportunity killer. The incidence of myocardial infarctions, reinfarctions, and death from infarctions are all two- to fourfold higher in men and more substantially increased in women. Similar statements can be made for strokes and peripheral vascular disease. Dr. Harris also discusses the differing effects of ethnic background on the prevalence of diabetic complications.
Microvascular disease is much more common in minorities.
ESRD is fourfold more common, and retinopathy is twice as common in African Americans as it is in whites. Among Latinos, retinopathy and proteinuria appear to be twice as common as in a comparable white population. In contrast, survival rates on dialysis are worse among whites, and, in contrast to microvascular disease, coronary heart disease is less common in minorities. The major risk factor for microvascular disease is hyperglycemia, and this persists when patients are stratified by age or insulin treatment. These relationships hold in whites and in Mexican Americans.