Coronary Artery Disease in IDDM

Abstract

Insulin-dependent diabetes mellitus (IDDM) increases the risk of developing coronary artery disease (CAD) compared with that seen in the general population, while the sex differential in rates of CAD is considerably reduced in IDDM populations. To further our understanding of these observations, the effects of gender on baseline risk factors for CAD incidence were examined. Participants in the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study were recruited from the Children's Hospital of Pittsburgh IDDM registry and had been diagnosed between 1950 and 1980. Subjects completed a series of questionnaires and were given a full clinical examination at baseline (1986 through 1988) and every subsequent 2 years. This report is based on the first 4 years of follow-up. Similar incidence rates of new CAD events were observed in men and women. In neither sex was glycemic control a predictor of later CAD. Sex-specific Cox proportional hazards models showed that for men, duration of IDDM, HDL cholesterol, fibrinogen, hypertension, and smoking were all significantly associated with the onset of CAD. Hypertension, fibrinogen, and smoking were all replaced by nephropathy when this latter variable was added to the model. For women, duration, hypertension, waist-hip ratio, physical activity, and depressive symptomatology were all significant independent predictors of CAD. Nephropathy status did not enter the model for women. While 4-year incidence of CAD in IDDM varies little by sex in this population, the predictive risk factors vary considerably. In particular, the effect of renal disease was stronger in men, while the cluster of physical activity, waist-to-hip ratio, and depressive symptomatology were more important in women. These results may help explain the relatively greater impact IDDM has on CAD risk for women and suggest new potential preventive approaches.

A Contemporary Estimate of Total Mortality and Cardiovascular Disease Risk in Young Adults With Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study

“…The relative excess being greater in women than men also likely reflects CVD being rarer in women in this age group in the general population. In the EDC Study, depressive symptomatology was found to be associated with CAD incidence in women, but not in men, suggesting that nontraditional risk factors may also help explain sex differences (33). …”

Spectrum and Prevalence of Atherogenic Risk Factors in 27,358 Children, Adolescents, and Young Adults With Type 1 Diabetes

“…Raised blood pressure and current smoking were lower in female than in male subjects, whereas increased A1C, total cholesterol, LDL cholesterol, and BMI values emerged in female subjects. It is known that women with type 1 diabetes have an increased risk of developing CVD and, therefore, equalizing the sex difference seen in the general population (32). In addition to the risk factors discussed here, several variables are related to CVD in women such as age, fasting triglyceride levels, albumin excretion rate, retinopathy, fat distribution, and depressive symptomatology (15,33).…”

Risk stratification for 25-year cardiovascular disease incidence in type 1 diabetes: Tree-structured survival analysis of the Pittsburgh Epidemiology of Diabetes Complications study

“…This supports the earlier observation that renal disease may be a more important CVD risk factor in men compared to women. 4 Non-HDLc discriminated risk in men only if AER was lower. In women, diabetes duration was the major discriminating factor and non-HDLc further discriminated CVD risk in those with shorter diabetes duration.…”

“…2,3 Notably, the sex difference in CVD incidence observed in the general population seems to be narrowed in type 1 diabetes, so that women have nearly the same risk as men. 4,5 …”

“…1 There is also evidence that the risk factors for CVD differ in men and women, despite their nearly equal risk of developing CVD. 4 …”