Sex Differences in the Effect of Diabetes Duration on Coronary Heart Disease Mortality

Natarajan, Sundar; Liao, Youlian; Sinha, D.; Cao, Guichan; McGee, Daniel; Lipsitz, Stuart R.

doi:10.1016/j.accreview.2005.04.051

Cited by 29 publications

(47 citation statements)

References 15 publications

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“…A high relative risk of CHD mortality among type 2 diabetic women could be also due to the superior survival of women without diabetes (26). Finally, some studies have reported that a long duration of diabetes increases further the risk of CHD death (9,10,13,17).…”

Section: -Chd Mortality Kaplan-meier Estimates Of Chd Death During Amentioning

confidence: 99%

“…Furthermore, the age range has been variable, including relatively young (25-44 years) and old (65-85 years) subjects, making the comparison between the studies difficult, because diabetes is a considerably weaker risk factor for CHD death in elderly individuals (11,17). In several studies in which CHD mortality has been analyzed separately in men and women, the effect of diabetes status, compared with the effect of prior CHD, has been greater in women than in men (8,9,14,15,18). This is not surprising because women with diabetes lose their relative protection against cardiovascular complications (2,24,25).…”

Section: -Chd Mortality Kaplan-meier Estimates Of Chd Death During Amentioning

confidence: 99%

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Type 2 Diabetes as a “Coronary Heart Disease Equivalent”

et al. 2005

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OBJECTIVE -The purpose of this study was to investigate the hypothesis that coronary heart disease (CHD) mortality in diabetic subjects without prior evidence of CHD is equal to that in nondiabetic subjects with prior myocardial infarction or any prior evidence of CHD.RESEARCH DESIGN AND METHODS -During an 18-year follow-up total, cardiovascular disease (CVD) and CHD deaths were registered in a Finnish population-based study of 1,373 nondiabetic and 1,059 diabetic subjects.RESULTS -Adjusted multivariate Cox hazard models indicated that diabetic subjects without prior myocardial infarction, compared with nondiabetic subjects with prior myocardial infarction, had a hazard ratio (HR) of 0.9 (95% CI 0.6 -1.5) for the risk of CHD death. The corresponding HR was 0.9 (0.5-1.4) in men and 1.9 (0.6 -6.1) in women. Diabetic subjects without any prior evidence of CHD (myocardial infarction or ischemic electrocardiogram [ECG] changes or angina pectoris), compared with nondiabetic subjects with prior evidence of CHD, had an HR of 1.9 (1.4 -2.6) for CHD death (men 1.5 [1.0 -2.2]; women 3.5 [1.8 -6.8]). The results for CVD and total mortality were quite similar to those for CHD mortality.CONCLUSIONS -Diabetes without prior myocardial infarction and prior myocardial infarction without diabetes indicate similar risk for CHD death in men and women. However, diabetes without any prior evidence of CHD (myocardial infarction or angina pectoris or ischemic ECG changes) indicates a higher risk than prior evidence of CHD in nondiabetic subjects, especially in women. Diabetes Care 28:2901-2907, 2005T ype 2 diabetes increases the risk of coronary heart disease (CHD) events at least by two-to threefold in type 2 diabetic subjects compared with nondiabetic subjects (1). In type 2 diabetic women the relative risk is even greater (2). The reasons for this increased risk are largely unknown but could be related at least in part to more adverse changes in cardiovascular risk factors among diabetic women compared with diabetic men. Although the incidence of CHD events in nondiabetic subjects has considerably decreased during the last decades, this is not true for type 2 diabetic patients, particularly for women (3).We previously reported that type 2 diabetic patients without a history of prior myocardial infarction have the same risk of CHD death as nondiabetic subjects with a history of prior myocardial infarction (4). This observation has led to the conclusion that type 2 diabetes is a CHD equivalent and has had a profound effect, particularly on the recommendations for treatment of dyslipidemia (5).During recent years other studies have investigated the same question in different populations and study settings. Contradictory results have been obtained, with some studies confirming our original findings (6 -10) and some studies reporting opposite results, especially among men (11-18). The conclusion of these studies is that type 2 diabetes might be a CHD equivalent, but only among women.Our original study population included 1,059 patients ...

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Section: -Chd Mortality Kaplan-meier Estimates Of Chd Death During Amentioning

confidence: 99%

Section: -Chd Mortality Kaplan-meier Estimates Of Chd Death During Amentioning

confidence: 99%

Type 2 Diabetes as a “Coronary Heart Disease Equivalent”

et al. 2005

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“…Data about the reasons for this ex- cess risk of cardiovascular disease in diabetic women are conflicting. In a number of studies (7,8,14), differences in the distributions of other major risk factors explained the sex difference in cardiovascular disease risk to a great extent. A recently published meta-analysis established an estimate of the odds ratio for fatal and nonfatal cardiovascular disease due to diabetes in both women and men.…”

Section: Results -mentioning

confidence: 99%

Section: Diabetes Care 29:1851-1855 2006mentioning

confidence: 99%

“…Type 2 diabetes substantially contributes to the 500,000 women dying annually of cardiovascular disease in the U.S. It is unclear whether the difference in cardiovascular risk between the sexes is caused by known cardiovascular risk factors (like duration of diabetes and systolic blood pressure) or by lower health care utilization by women compared with men (7,8).In the present study, we extended the prospective follow-up of normotensive patients with type 2 diabetes and microalbuminuria who participated in a double-blind, randomized, placebo-controlled trial (9). The original study excluded patients with a history of cardiovascular disease, and the prolonged follow-up study removed differences in health care utilization among the participants.…”

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Normotensive Women With Type 2 Diabetes and Microalbuminuria Are at High Risk for Macrovascular Disease

Zandbergen

Sijbrands²,

Lamberts³

et al. 2006

Diabetes Care

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OBJECTIVE -The excess risk of macrovascular disease and death associated with diabetes seems higher in women than in men. The pathogenesis for this risk difference has not been fully elucidated. We investigated whether female sex was associated with macrovascular disease and death, independently of known risk factors related to type 2 diabetes, nephropathy, or retinopathy in normotensive patients with type 2 diabetes and microalbuminuria.RESEARCH DESIGN AND METHODS -We conducted a prospective, prolonged follow-up study of a subgroup of 67 diabetic patients (46 men and 21 women) without established cardiovascular disease who participated in a larger clinical trial. Data were collected on current and past health, medication use, blood pressure, renal function, and HbA 1c during the follow-up period of 4.7 Ϯ 0.8 (means Ϯ SE) years. The end point was a composite of death, cardiovascular disease, cerebrovascular events, and peripheral artery disease.RESULTS -Of the women, eight (38.1%) met the end point compared with six (13.4%) of the men (P ϭ 0.02 for difference in event-free survival). The hazard ratio of women relative to men was 3.19 (95% CI 1.11-9.21), which further increased after adjusting for age, systolic blood pressure, BMI, smoking, total-to-HDL cholesterol ratio, urinary albumin excretion, and retinopathy.CONCLUSIONS -In our study population of normotensive patients with type 2 diabetes and microalbuminuria, female sex was associated with increased risk of fatal and nonfatal cardiovascular disease, independent of the classical cardiovascular risk factors, the severity of nephropathy or presence of retinopathy, or health care utilization. Diabetes Care 29:1851-1855, 2006T ype 2 diabetes, with its rapidly growing prevalence, has become a major public health problem (1). It associates with an increased risk of coronary heart disease, cerebrovascular disease, and peripheral vascular disease (2,3). Strikingly, this excess risk for cardiovascular disease seems relatively higher for female than for male diabetic patients (3-6). Type 2 diabetes substantially contributes to the 500,000 women dying annually of cardiovascular disease in the U.S. It is unclear whether the difference in cardiovascular risk between the sexes is caused by known cardiovascular risk factors (like duration of diabetes and systolic blood pressure) or by lower health care utilization by women compared with men (7,8).In the present study, we extended the prospective follow-up of normotensive patients with type 2 diabetes and microalbuminuria who participated in a double-blind, randomized, placebo-controlled trial (9). The original study excluded patients with a history of cardiovascular disease, and the prolonged follow-up study removed differences in health care utilization among the participants.In this study, we investigated whether female sex was associated with cardiovascular disease, cerebrovascular disease, peripheral artery disease, and death, independently of the classical cardiovascular risk factors related to type 2 diabetes, neph...

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Reactions of Cationic Gold(I) with Allenoates: Synthesis of Stable Organogold(I) Complexes and Mechanistic Investigations on Gold‐Catalyzed Cyclizations

Liu

Hammond

2009

Chemistry An Asian Journal

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The reaction of allenoates with cationic gold(I)-generated in situ from a phosphine gold chloride and a silver salt-formed unusual, room temperature stable vinyl gold(I) lactones under very mild conditions. The scope and limitations for the synthesis of this novel organogold complex was investigated. DFT calculations on the highest occupied molecular orbitals (HOMOs) of allenoates and the natural bond orbital (NBO) charge densities provided an explanation for the limitations. A plausible mechanism for its formation was proposed based on in situ (1)H and (31)P NMR spectroscopic analyses. Controlled experiments for the cleavage of the gold-carbon bond by electrophiles indicated that this vinyl gold(I) complex is the likely intermediate in the gold-catalyzed reaction of carbon-carbon multiple bonds.

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Sex Differences in the Effect of Diabetes Duration on Coronary Heart Disease Mortality

Cited by 29 publications

References 15 publications

Type 2 Diabetes as a “Coronary Heart Disease Equivalent”

Type 2 Diabetes as a “Coronary Heart Disease Equivalent”

Normotensive Women With Type 2 Diabetes and Microalbuminuria Are at High Risk for Macrovascular Disease

Reactions of Cationic Gold(I) with Allenoates: Synthesis of Stable Organogold(I) Complexes and Mechanistic Investigations on Gold‐Catalyzed Cyclizations

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