Type 2 diabetes substantially increases the risk for heart disease, but a large review of studies has found that women with diabetesare at much higher risk than men.

The meta-analysis, published in Diabetologia, included 64 studies with 858,507 subjects and 28,203 heart attacks and other coronary events.

The studies adjusted for various other cardiovascular risk factors, including age, blood pressure, cholesterol, smoking and body mass index. But when considering diabetes as an independent risk, they found that compared with diabetic men, diabetic women were at a 44 percent higher risk for both fatal and nonfatal cardiovascular events.

The reasons remain unclear, but the study’s lead author, Sanne A. E. Peters, an epidemiologist at University Medical Center Utrecht, suggested that the finding was not because of differences in treatment or physiological differences between the sexes in the effects of diabetes. Rather, it may be a result of the more severe deterioration of women before the onset of diabetes. .

“It may be that women have to gain much more weight than men before they become diabetic,” she said. “So they may already be at higher risk for coronary heart disease at diagnosis, although there is no proof that this is true.

“Screening for diabetes should be different in women than in men,” Dr. Peters continued. “Coronary heart disease is sometimes considered a man’s disease, but women are at risk as well.”