Gender Difference in the Impact of Type 2 Diabetes on Coronary Heart Disease Risk

Abstract

OBJECTIVE -To explain the stronger effect of type 2 diabetes on the risk of coronary heart disease (CHD) in women compared with men. RESEARCH DESIGN AND METHODS -The study population consisted of 1,296 nondiabetic subjects and 835 type 2 diabetic subjects aged 45-64 years without cardiovascular disease. The end points were CHD death and a major CHD event (CHD death or nonfatal myocardial infarction). The follow-up time was 13 years.RESULTS -Major CHD event rate per 1,000 person-years was 11.6 in nondiabetic men, 1.8 in nondiabetic women, 36.3 in diabetic men, and 31.6 in diabetic women. The diabetes-related hazard ratio for a major CHD event from the Cox model, adjusted for age and area of residence, was 2.9 (95% CI 2.2-3.9) in men and 14.4 (8.4 -24.5) in women, and after further adjustment for cardiovascular risk factors, 2.8 (2.0 -3.7) and 9.5 (5.5-16.9), respectively. The burden of conventional risk factors in the presence of diabetes was greater in women than in men at baseline. Prospectively, elevated blood pressure, low HDL cholesterol, and high triglycerides contributed to diabetes-related CHD risk more in women than in men. However, after adjusting for conventional risk factors, a substantial proportion of diabetes-related CHD risk remained unexplained in both genders.CONCLUSIONS -The stronger effect of type 2 diabetes on the risk of CHD in women compared with men was in part explained by a heavier risk factor burden and a greater effect of blood pressure and atherogenic dyslipidemia in diabetic women. Diabetes Care 27:2898 -2904, 2004T ype 2 diabetes increases the risk of coronary heart disease (CHD) more markedly in women than in men. However, the reported magnitudes of the diabetes-related CHD risk in men and women vary widely between different studies (1-5). The greater relative risk of CHD in diabetic women still remains incompletely understood, but several explanations can be offered. First, adverse changes induced by type 2 diabetes in some cardiovascular risk factors, such as HDL cholesterol, triglycerides, LDL particle size, and blood pressure, have been found to be more pronounced in women than in men (6 -8). Second, it is possible that gender may alter the effect of some cardiovascular risk factors for CHD in diabetic subjects, leading to a stronger risk effect in women. Third, diabetes in women may interfere more with protective mechanisms in the vascular wall and thereby lead to enhanced atherogenesis and/or thrombogenesis (9).In the present study, based on 13 years of follow-up of 1,296 nondiabetic and 835 type 2 diabetic subjects, we evaluated possible explanations for the stronger effect of type 2 diabetes on the risk of CHD in women than in men.RESEARCH DESIGN AND METHODS -Altogether, 1,059 subjects (581 men and 478 women) with type 2 diabetes aged 45-64 years and born and living in the Turku University Hospital district in West Finland and in the Kuopio University Hospital district in East Finland were identified through a national drug reimbursement register. A random sample of nondiab...

Metabolic effects of interventions to increase exercise in adults with type 2 diabetes

“…It is possible that, compared with men, women do not achieve similar exercise intensities, decrease spontaneous activity to a greater extent when enrolled in exercise studies [39], experience smaller increases in resting metabolic rate, or experience smaller fitness gains [37,39,40]. Differences between the sexes in diabetes disease characteristics have been reported but are not well understood [41][42][43][44][45][46]. Future primary studies should examine differences between men and women within studies to provide more information on this issue.…”

Asociación entre diabetes mellitus y patología cardiovascular en la población adulta de Chile: estudio de la Encuesta Nacional de Salud 2009-2010

“…Posteriormente, numerosos estudios poblacionales de observación han corroborado esta observación [24][25][26][27][28][29][30] .…”

“…En el estudio poblacional de Kuopio, Finlandia, se concluyó que el mayor efecto de la DM en la mujer sobre su salud cardiovascular se podría deber al mayor impacto que tendría la hipertensión arterial y la dislipidemia aterogénica, ambas consecuencias de la resistencia insulínica, en estas pacientes 25 .…”

Does Sex Influence Dyslipedemia in Non Obese Hypertensivetype 2 Diabetes Mellitus?

“…. Diabetic females have been reported to have significantly low level of HDL by Gilani et al 8 while in other studies females had higher triglycerides and Blood P compared to their male diabetic counterpart 9 . There is a 2-4 times increase in the risk of cardiovascular diseases in women compared to men 10,11,12 .…”

“…Although the patients were on oral hypoglycaemic drugs their glycemic status (HbA1c > 7) 16 reflects a poor control of diabetes with their lipid profile deranged. Previous studies show that females are more prone to develop cardiovascular complications of diabetes mellitus due to dyslipidemia 8,9,15 . According to syed et al; low levels of HDL in diabetic female plays an important role in development of CHD 8 .…”