Chanchal ChandramouliTiew Hwa Katherine TengWan Ting TayJonathan YapMichael R. MacDonaldJasper TrompLimin YanBambang SiswantoEugenio B. ReyesTachapong NgarmukosCheuk Man YuChung Lieh HungInder AnandA. Mark RichardsLieng Hsi LingJudith G. RegensteinerCarolyn S.P. LamA. Mark RichardsCarolyn S.P. LamInder AnandChung Lieh HungLieng Hsi LingHoung Bang LiewCalambur NarasimhanSang Weon ParkEugenio ReyesBambang B. SiswantoWataru ShimizuShu ZhangManila Doctors HospitalCare Hospital HyderabadUniversitas IndonesiaMackay Memorial Hospital TaiwanUniversity of Colorado School of MedicineNippon Medical SchoolUniversity of OtagoNational University of SingaporeFaculty of Medicine, Ramathibodi Hospital, Mahidol UniversityVA Medical CenterChangi General HospitalUniversity of Minnesota Medical SchoolUniversity of Groningen, University Medical Center GroningenNational Heart Centre, SingaporeChinese University of Hong KongQueen Elizabeth HospitalCardiovascular Research InstituteFuwai Cardiovascular HospitalSejong General Hospital2020-01-272020-01-272019-03-01European Journal of Heart Failure. Vol.21, No.3 (2019), 297-30718790844138898422-s2.0-85058157463https://repository.li.mahidol.ac.th/handle/20.500.14594/51845© 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology Aims: To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM). Methods and results: Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m 2 , P interaction = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33–2.57 vs. OR 1.32, 95% CI 1.11–1.56, P interaction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (P interaction = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24–2.60 vs. HR 1.32, 95% CI 1.12–1.56; P interaction = 0.005). Conclusions: Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.Mahidol UniversityMedicineArticleSCOPUS10.1002/ejhf.1358