A strong correlation between diabetes and heart disease has long been accepted in the medical community.

Now, new findings published in Diabetologia suggest that women with diabetes have a higher risk of heart failure than men with the same condition.

Women with Type 1 diabetes have a 47% increased risk of heart failure over men, while those with Type 2 diabetes have a 9% increased risk.

The paper reviewed 14 previously completed studies that included more than 12 million people, and found that women with Type 1 or Type 2 diabetes were more likely to suffer heart failure than their male counterparts.

In fact, women with Type 1 diabetes have a 47% increased risk of heart failure over men, while those with Type 2 diabetes have a 9% increased risk, according to the findings. The reason for the disparity between Type 1 and Type 2 diabetes is unclear.

But the paper does suggest why women are at a greater risk than men.

First, women with diabetes also suffer higher rates of coronary heart disease, a cause of heart failure. Women have also been historically under-treated for diabetes, which can lead to diabetic cardiomyopathy (a type of damage to the heart muscle).

And, women have reportedly experienced two more years of prediabetes than men, which is associated with function of the heart’s left ventricle.

Dr. Fernando Ovalle, director of the University of Alabama at Birmingham‘s Division of Endocrinology Diabetes and Metabolism, who was not involved in the report, told CNN, “[T]his points out … two things: It seems to be stronger in Type 1 than in Type 2, and stronger in women than in men.”

While the paper says further research is needed to understand why diabetes causes the increased risk of heart failure in women, they highlight the importance of prevention and treatment. Women with diabetes should exercise regularly, eat a balanced diet, maintain a healthy weight, and control cholesterol levels, plus get regular health screenings to stay on track.

“Both practitioners, as well as women with diabetes, should certainly be on the lookout for heart failure-type symptoms,” Dr. E. Dale Abel, chairman of the Department of Internal Medicine and director of the Fraternal Order of Eagles Diabetes Research Center at the University of Iowa in Iowa City, told CNN.

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