Relatively more atherogenic coronary heart disease risk factors in prediabetic women than in prediabetic men

Haffner, S M; Miettinen, Heikki; Stern, Michael P.

doi:10.1007/s001250050738

Cited by 92 publications

(65 citation statements)

References 39 publications

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“…It is unclear whether these factors act differentially in women versus men, but our findings and those of others suggest that there may be some pathophysiological differences between sexes. Indeed, Haffner et al (14) have shown that diabetic women tend to be older and tend to have a higher likelihood of associated hypertension than do their male counterparts. Also, the relationship between diabetes and endothelial function may interestingly vary between sexes, as revealed in an elegant study by Steinberg et al (15) showing that diabetes is an important predictor of endothelial dysfunction in women, while obesity is a more important contributor to endothelial dysfunction in men.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in the Prognostic Importance of Diabetes in Patients With Ischemic Heart Disease Undergoing Coronary Angiography

Graham

Ghali²,

Faris³

et al. 2003

Diabetes Care

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FOR THE APPROACH INVESTIGATORSOBJECTIVE -Women with ischemic heart disease have poorer outcomes than men and are suggested to have greater risk associated with diabetes. We evaluated the prognosis associated with diabetes, in analyses stratified by sex, to determine whether similar differences are seen in a large unselected cohort of patients. RESEARCH DESIGN AND METHODS -Using the Alberta Provincial Project forOutcomes Assessment in Coronary Heart Disease (APPROACH), a clinical data collection and follow-up initiative capturing all patients undergoing cardiac catheterization in Alberta, Canada, the relative significance of diabetes on long-term survival in 13,152 men and 4,249 women was evaluated in patients presenting with or without myocardial infarction and according to first treatment received.RESULTS -The 1-year mortality rates were 4.7% and 6.8% in men and women (P Ͻ 0.001), 4.1% and 7.4% in nondiabetic and diabetic men (P Ͻ 0.001), and 5.8% and 9.6% in nondiabetic and diabetic women, respectively (P Ͻ 0.001). The risk-adjusted Cox proportional hazard ratios associated with diabetes in myocardial infarction were 1.03 in men and 1.20 in women. The diabetes hazard ratios for percutaneous coronary intervention were 1.28 in men and 1.40 in women, 1.23 in men and 1.32 in women for bypass surgery, and 1.26 in men and 1.31 in women for medical therapy (P ϭ NS for all diabetes hazard ratio comparisons between men and women).CONCLUSIONS -Hazard ratios quantifying the adverse prognosis associated with diabetes in patients undergoing angiography are consistently higher among women than men, but the differences across sexes are not statistically significant. These slight sex differences noted in the APPROACH registry are similar to previously reported findings and may be clinically important.

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Section: Discussionmentioning

confidence: 99%

Sex Differences in the Prognostic Importance of Diabetes in Patients With Ischemic Heart Disease Undergoing Coronary Angiography

Graham

Ghali²,

Faris³

et al. 2003

Diabetes Care

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“…However, a gender-specific effect of chronic inflammation on insulin resistance might help to explain the results from the San Antonio Heart Study that showed that women who developed diabetes experienced a greater change in MetS-associated risk factors compared with the corresponding group of men. 31 The same pathobiology might help to explain why the development of diabetes is associated with a greater increase in dyslipidemia and relative risk for CVD in women than in men. 32,33 …”

Section: Gender Influencementioning

confidence: 99%

C-Reactive Protein, the Metabolic Syndrome, and Prediction of Cardiovascular Events in the Framingham Offspring Study

et al. 2004

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Background-Inflammation (assessed by C-reactive protein [CRP]) and the metabolic syndrome (MetS) are associated with cardiovascular disease (CVD), but population-based data are limited. Methods and Results-We assessed the cross-sectional relations of CRP to the MetS (National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III definition) in 3037 subjects (1681 women; mean age, 54 years) and the utility of CRP and the MetS to predict new CVD events (nϭ189) over 7 years. MetS (Ն3 of 5 traits) was present in 24% of subjects; mean age-adjusted CRP levels for those with 0, 1, 2, 3, 4, or 5 MetS traits were 2.2, 3.5, 4.2, 6.0, or 6.6 mg/L, respectively (P trend Ͻ0.0001).In persons with MetS, age-adjusted CRP levels were higher in women than men (7.8 versus 4.6 mg/L; PϽ0.0001). MetS and baseline CRP were individually related to CVD events (for MetS: age-sex-adjusted hazard ratio [HR], 2.1; 95% CI, 1.5 to 2.8; for highest versus lowest CRP quartile: HR, 2.2; 95% CI, 1.4 to 3.5). Greater risk of CVD persisted for MetS and CRP even after adjustment in a model including age, sex, MetS (HR, 1.8; 95% CI, 1.4 to 2.5), and CRP (HR, 1.9; 95% CI, 1.2 to 2.9). The c-statistic associated with the age-and sex-adjusted model including CRP was 0.72; including MetS, 0.74; and including CRP and MetS, 0.74. Conclusions-Elevated CRP levels are related to insulin resistance and the presence of the MetS, especially in women.Although discrimination of subjects at risk of CVD events using both MetS and CRP is not better than using either phenotype alone, both CRP and MetS are independent predictors of new CVD events.

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“…Although most women with GDM return to normal glucose tolerance after delivery, it is well established that glucose intolerance detected during pregnancy is predictive of later maternal type 2 diabetes (10,11). Particularly, women with impaired glucose metabolism or diabetes carry a greater cardiovascular risk than normoglycemic individuals (12). Indeed, women with prior GDM (pGDM) feature endothelial dysfunction that is associated with insulin resistance (13)(14)(15) and obesity, which are the most prominent risk factors for GDM and type 2 diabetes in pGDM and linked to both inflammatory processes and angiopathy (16).…”

mentioning

confidence: 99%

Plasma Adiponectin, Insulin Sensitivity, and Subclinical Inflammation in Women With Prior Gestational Diabetes Mellitus

Winzer

Wagner²,

Festa³

et al. 2004

Diabetes Care

171

138

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OBJECTIVE -Women with prior gestational diabetes mellitus (pGDM) are at increased risk of developing type 2 diabetes and associated vasculopathy. Because increased fat mass and inflammatory processes are angiopathic risk factors, the relationship between insulin sensitivity, parameters of subclinical inflammation, and plasma concentrations of adipocytokines was investigated in pGDM both at 3 months and 12 months after delivery.RESEARCH DESIGN AND METHODS -Insulin sensitivity (through a frequently sampled intravenous glucose tolerance test) and plasma concentrations of ultrasensitive C-reactive protein (CRP), adiponectin, plasminogen activator inhibitor (PAI)-1, tumor necrosis factor-␣, leptin, and interleukin-6 were measured in 89 pGDM (BMI 26.9 Ϯ 0.5 kg/m 2 , age 32 Ϯ 0.5 years) and in 19 women with normal glucose tolerance during pregnancy (NGT) (23.7 Ϯ 0.9 kg/m 2 , 31 Ϯ 1.3 years).RESULTS -pGDM showed lower (P Ͻ 0.0001) plasma adiponectin (6.7 Ϯ 0.2 g/ml) than NGT (9.8 Ϯ 0.6 g/ml) and a decreased (P Ͻ 0.003) insulin sensitivity index (S i ) and disposition index (P Ͻ 0.03), but increased plasma leptin (P Ͻ 0.003), PAI-1 (P Ͻ 0.002), and CRP (P Ͻ 0.03). After adjustment for body fat mass, plasma adiponectin remained lower in pGDM (P Ͻ 0.004) and correlated positively with S i (P Ͻ 0.003) and HDL cholesterol (P Ͻ 0.0001) but negatively with plasma glucose (2-h oral glucose tolerance test [OGTT]) (P Ͻ 0.0001), leptin (P Ͻ 0.01), CRP (P Ͻ 0.007), and PAI-1 (P Ͻ 0.0001). On regression analysis, only HDL cholesterol, postload (2-h OGTT) plasma glucose, and S i remained significant predictors of plasma adiponectin, explaining 42% of its variability. Of note, adiponectin further decreased (P Ͻ 0.05) only in insulin-resistant pGDM despite unchanged body fat content and distribution after a 1-year follow-up.CONCLUSIONS -Lower plasma adiponectin concentrations characterize women with previous GDM independently of the prevailing insulin sensitivity or the degree of obesity and are associated with subclinical inflammation and atherogenic parameters. Diabetes Care 27:1721-1727, 2004P lasma concentrations of adiponectin, an adipocyte-specific collagenlike molecule, are reduced in patients with obesity, coronary artery disease, and type 2 diabetes (1). Longitudinal studies indicate that a decrease in plasma adiponectin parallels the progression of the metabolic syndrome (2,3). Potentially, this observation suggests a predictive role of adiponectin also in the development of type 2 diabetes and atherosclerosis, where it could relate to insulin sensitivity and atherogenic parameters such as the lipid profile, cytokines, and subclinical inflammation. This concept is supported by low plasma adiponectin concentrations in states of enhanced insulin resistance in rhesus monkeys (4) and humans (5), when low plasma adiponectin precedes the decrease in whole-body insulin sensitivity (6,7). Moreover, adiponectin decreases both the attachment of monocytic THP-1 cells to human aortic endothelial cells and suppresses the secretion of tumo...

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Relatively more atherogenic coronary heart disease risk factors in prediabetic women than in prediabetic men

Cited by 92 publications

References 39 publications

Sex Differences in the Prognostic Importance of Diabetes in Patients With Ischemic Heart Disease Undergoing Coronary Angiography

Sex Differences in the Prognostic Importance of Diabetes in Patients With Ischemic Heart Disease Undergoing Coronary Angiography

C-Reactive Protein, the Metabolic Syndrome, and Prediction of Cardiovascular Events in the Framingham Offspring Study

Plasma Adiponectin, Insulin Sensitivity, and Subclinical Inflammation in Women With Prior Gestational Diabetes Mellitus

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