Association between diabetes and coronary heart disease in Aboriginal people: are women disadvantaged?

OBJECTIVES To determine the incidence rate of coronary heart disease (CHD) in Australian Aboriginal people with type 2 diabetes, and to compare the impact of diabetes on CHD risk in Aboriginal women and men. DESIGN Cohort study. SETTING A remote Aboriginal community in the Northern Territory. PARTICIPANTS 889 Aboriginal people aged 20-74 years followed up to 31 May 2003 after baseline examination in 1992-1995. MAIN OUTCOME MEASURES Incidence rates of CHD (estimated for 123 participants with diabetes at baseline and 701 "non-diabetes" participants); rate ratios for diabetes risk (95% CI), with "non-diabetes" participants as the reference group. RESULTS Participants with diabetes at baseline had a higher rate of CHD (37.5 per 1000 person-years) than those without diabetes (7.3 per 1000 person-years). Adjustment for multiple CHD risk factors, such as age, smoking, alcohol consumption, systolic blood pressure, body mass index, high-density lipoprotein cholesterol and total cholesterol levels, resulted in a CHD rate ratio for women of 3.7 (95% CI, 1.6-8.9) (comparing women with diabetes with those without) and a CHD rate ratio for men of 1.4 (95% CI, 0.4-4.1) (comparing men with diabetes with those without). CONCLUSIONS Aboriginal women with diabetes experienced a significantly higher risk of CHD than women without diabetes. Although the difference was not statistically significant, women with diabetes had a higher CHD risk than men with diabetes.