OBJECTIVE -We examined whether biomarkers of endothelial function, fibrinolysis/ thrombosis and adiponectin, predict the progression from normal to pre-diabetes more strongly among women than men over 6 years of follow-up from the Western New York Health Study. participants from the Western New York Health Study, who were free of type 2 diabetes and cardiovascular disease at baseline (1996 -2001), were selected for reexamination. An incident case of pre-diabetes was defined as fasting glucose Ͻ100 mg/dl at the baseline examination and Ն100 and Ͻ126 mg/dl at the follow-up examination. Biomarkers of endothelial function (E-selectin and soluble intracellular adhesion molecule-1 [sICAM-1]), fibrinolysis/thrombosis (plasminogen activator inhibitor-1 [PAI-1]), and fasting insulin, adiponectin, and inflammation (high-sensitivity C-reactive protein) were measured in frozen (Ϫ190°C) baseline samples. RESEARCH DESIGN AND METHODSRESULTS -Multivariate analyses revealed higher adjusted mean values of biomarkers of endothelial dysfunction (E-selectin and sICAM-1) and fibrinolysis (PAI-1) and lower mean values of adiponectin only among women who developed pre-diabetes compared with control subjects. Formal tests for interaction between sex and case/control status were statistically significant for E-selectin (P ϭ 0.042), PAI-1 (P ϭ 0.001), sICAM-1 (P ϭ 0.011), and frequency of hypertension (P Ͻ 0.001).CONCLUSIONS -These results support the concept that women who progressed from normoglycemia to pre-diabetes have greater endothelial dysfunction than men as well as more hypertension and a greater degree of fibrinolysis/thrombosis. Whether this relates to the higher risk of heart disease among diabetic women awaits further study. Diabetes Care 30:354 -359, 2007D eath rates from coronary heart disease (CHD) in the U.S. have fallen dramatically over the last several decades; however, the rate of decline has been greater among men than among women (1). The factors underlying this sex difference are unclear (2-6). It has also been suggested that women, especially those with type 2 diabetes, are more likely to have coronary microvascular disease than men (7,8). It is well known that diabetic women have a much higher risk for CHD than their male counterparts, a risk not completely explained by traditional biological and psychosocial factors (9,10).Previous studies have shown that the frequency of nonfatal myocardial infarction is increased before the clinical diagnosis of type 2 diabetes (11) and that women with impaired glucose tolerance tend to have a more atherogenic risk profile than their male counterparts years before the diagnosis of clinical diabetes (12). This observation has led to the "ticking clock" hypothesis (13), wherein the elevated CHD risk among diabetic individuals may be due more to their longstanding atherogenic risk profile than to hyperglycemia per se, which is more strongly associated with the risk of microvascular events (14). Recently, attention has been focused on the role of emerging risk factors including ...

OBJECTIVE -We conducted a nested case-control investigation to examine whether elevated baseline concentrations of cystatin C predicted progression from normoglycemia to prediabetes over 6 years of follow-up from the Western New York Health Study. participants from the Western New York Health Study, who were free of type 2 diabetes and known cardiovascular disease at baseline (1996 -2001), were reexamined. An incident case of pre-diabetes was defined as an individual with fasting glucose Ͻ100 mg/dl at the baseline examination and Ն100 and Յ125 mg/dl at the follow-up examination, thereby eliminating individuals with prevalent prediabetics. All case patients (n ϭ 91) were matched 1:3 to control participants based on sex, race/ethnicity, and year of study enrollment. All control subjects had fasting glucose levels Ͻ100 mg/dl at both baseline and follow-up examinations. Cystatin C concentrations and the urinary albumin-to-creatinine ratio were measured from frozen (Ϫ196°C) baseline blood and urine samples. Serum creatinine concentrations were available from the baseline examination only. RESEARCH DESIGN AND METHODSRESULTS -Multivariate conditional logistic regression analyses adjusted for age, baseline glucose level, homeostasis model assessment of insulin resistance, BMI, hypertension, estimated glomerular filtration rate, cigarette smoking, and alcohol use revealed a significantly increased risk of progression to pre-diabetes among those with elevated baseline concentrations of cystatin C (odds ratio 3.28 [95% CI 1.43-7.54]) (upper quintile versus the remainder). Results of secondary analyses that considered high-sensitivity C-reactive protein, interleukin-6, E-selectin, or soluble intercellular adhesion molecule-1 did not alter these results.CONCLUSIONS -These results suggest that cystatin C was associated with a threefold excess risk of progression to pre-diabetes in this population. Diabetes Care 30:1724-1729, 2007R ecent evidence from randomized clinical trials (1,2) among people with pre-diabetes have provided convincing evidence that early intervention can significantly delay or prevent the progression to type 2 diabetes. The identification of those with pre-diabetes is assuming greater importance (3), especially in light of the fact that ϳ37% of adults aged 40 -74 years in the U.S. have prediabetes defined as impaired fasting glucose (4). Microalbuminuria occurs frequently in nondiabetic subjects and places them at increased risk for cardiovascular disease (CVD) (5-7). The mechanisms behind this observation are poorly understood, however. Albuminuria may reflect underlying vascular damage (8), hypertension (9,10), endothelial dysfunction (11,12), and/or low-grade inflammation (13).A large percentage of individuals with type 2 diabetes pass through a period of pre-diabetes (14) and may experience early renal dysfunction, e.g., a glomerular filtration rate (GFR) Ͼ60 ml/min per 1.73 m 2 . Currently used estimating equations are poor at identifying early renal impairment and better indexes are of great interes...

Objective: To examine whether several biomarkers of endothelial function and inflammation improve prediction of type 2 diabetes over 5.9 years of follow-up, independent of traditional risk factors. Methods and Procedures: A total of 1,455 participants from the Western New York Study, free of type 2 diabetes at baseline, were selected. Incident type 2 diabetes was defined as fasting glucose exceeding 125 mg/dl or on antidiabetic medication at the follow-up visit. Sixty-one people who met the case definition (8/1,000 person years) were identified and individually matched with up to three controls on gender, race, year of study enrollment, and baseline fasting glucose (<110 or 110-125 mg/dl). Biomarkers were measured from frozen baseline samples. Results: In conditional logistic regression analyses accounting for traditional risk factors (age, family history of diabetes, smoking, drinking status, and BMI), E-selectin was positively related (3rd vs. 1st tertile: odds ratio 2.77, 95% confidence interval (CI) 1.13-6.79, P for linear trend = 0.023) and serum albumin was inversely related (3rd vs. 1st tertile: odds ratio 0.36, 95% CI 0.14-0.93, P for linear trend = 0.032) to type 2 diabetes incidence. The addition of E-selectin, serum albumin, and leukocyte count to a basic risk factor model including only traditional risk factors significantly increased the area under the receiver operating characteristic curve (AUC) (from 0.646 to 0.726, P value = 0.04). Discussion: These results support the role of endothelial dysfunction and subclinical inflammation as important mechanisms in the etiopathogenesis of type 2 diabetes; moreover, they indicate that novel biomarkers may improve the prediction of type 2 diabetes beyond the use of traditional risk factors alone.

Purpose-To determine whether cigarette smoking is associated with the conversion from normoglycemia to impaired fasting glucose (IFG). (1996)(1997)(1998)(1999)(2000)(2001) were reexamined (68% response rate). Incident IFG was defined as a subject whose baseline fasting plasma glucose was <100 mg/dl (normoglycemic) and between 100 and 125 mg/dl at follow-up. Prevalent IFG (n=528) was excluded.. Baseline smoking status was categorized as never, former or current. Methods-DuringResults-Of the 1,455 participants, 924 were normoglycemic at baseline: 101/924 converted to IFG over six-years. Compared to those who remained normoglycemic, converters to IFG were at baseline older, had a larger BMI, more likely to be hypertensive, currently smoke, and have a family history of T2DM (all P <0.05). Multivariate logistic regression demonstrated that compared to subjects who remained normoglycemic, the OR of incident IFG among former and current smokers (vs. never) was 1.68 (95% confidence interval: 0.99, 2.80) and 2.35 (95% confidence interval: 1.17, 4.72) (P trend =0.008), respectively. Conclusion-Smoking was positively associated with incident IFG after accounting for several putative risk factors.Keywords cigarette smoking; impaired fasting glucose; epidemiology; risk factors Type 2 diabetes mellitus (T2DM) is a formidable public health problem leading to premature morbidity and mortality and contributing to increased health care costs. Putative risk factors associated with the development of T2DM are age, ethnicity, obesity, family history of T2DM, and physical inactivity. Moreover, both the Diabetes Prevention Program and the Finish Correspondence and Reprints to:

There are many barriers to screening and prevention for cervical cancer in vulnerable populations. Newer technologies with HPV testing have helped to identify those women at highest risk for cervical cancer. Implementing strategies among healthcare providers to avoid missed opportunities for screening, assessment and education of risk factors, and offering vaccination against HPV are needed. Empowering women may begin to reduce disparities through the development of educational programs that reduce cultural and linguistic barriers to screening and awareness that socioeconomic factors may be impediments to care and adherence.