Risk for CVD in Women vs Men With Diabetes

Women with type 2 diabetes, but not prediabetes, may have a greater relative risk (RR) for prevalent cardiovascular disease than men, according to a study published in Diabetes Care.

In this cross-sectional study, the prevalence of CVD in 3540 Caucasian adults (ages >40 years) with normal glucose tolerance (NGT), prediabetes or diabetes enrolled in the Catanzaro Metabolic Risk factors (CATAMERI) study was examined. In a longitudinal study of 1658 adults with NGT, prediabetes, and diabetes from the CATAMERI study, incidence of major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events was examined at an average of 5.6 years of follow-up.

Women with diabetes (n=576; mean age, 63±10 years) had higher levels of cardiovascular risk factors than men, including body mass index (BMI), systolic blood pressure, total and low-density lipoprotein (LDL) cholesterol levels, high-sensitivity C-reactive protein (hs-CRP), white blood cell count, and fibrinogen level. Men with diabetes (n=846; mean age, 61±10 years) smoked more frequently and had significantly lower levels of high-density lipoprotein (HDL) cholesterol than women.

Women vs men with prediabetes and diabetes had greater relative differences in: BMI, waist circumference, blood pressure, total LDL, and HDL cholesterol, triglycerides, fasting glucose, hs-CRP, and white blood cell count.

Women vs men with diabetes, but not prediabetes, had a higher RR for prevalent CVD (RR, 9.29; 95% CI, 4.73-18.25; P <.0001).

In the longitudinal study, women with diabetes, but not those with prediabetes, were found to have a higher RR of incident major adverse outcomes than men with diabetes (women: RR, 5.25; 95% CI, 3.22-8.56; P <.0001; men:  RR 2.72; 95% CI, 1.81-4.08; P <.0001).

Study limitations include the fact that glucose tolerance was assessed orally and that HbA1c was only measured once, which may have led to some patients being misclassified.

“[T]hese data highlight the importance to identify individuals with prediabetes for targeting lifestyle intervention programs to reduce their risk of diabetes and CVD,” noted the study authors.

Reference

Succurro E, Fiorentino TV, Miceli S, et al. Relative risk of cardiovascular disease is higher in women with type 2 diabetes, but not in those with prediabetes, as compared with men [published online September 30, 2020]. Diabetes Care. doi: 10.2337/dc20-1401