Women with type 2 diabetes mellitus have a twofold greater risk of developing coronary heart disease, compared with men with type 2 diabetes, according to a scientific statement from the American Heart Association.
In outlining the many sex differences in the impact of diabetes on cardiovascular disease risk, the authors of the statement have also called for more research into why there are these sex differences and how to treat them.
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Around 1 in 10 adult Americans are estimated to have diabetes, and among those individuals, cardiovascular disease alone accounts for more than three-quarters of hospitalizations and half of all deaths.
“Although nondiabetic women have fewer cardiovascular events than nondiabetic men of the same age, this advantage appears to be lost in the context of [type 2 diabetes],” wrote American Heart Association Diabetes Committee Cochair Dr. Judith G. Regensteiner, director of the Center for Women’s Health Research at the University of Colorado at Denver, Aurora, and her coauthors.
Women with type 2 diabetes experience myocardial infarctions earlier in life than do men and are more likely to die from them, yet the rates of revascularization are lower in women with diabetes, compared with men, according to a statement published in the December 7 online issue of Circulation.
Women with diabetes also have more impaired endothelium-dependent vasodilation, worse atherogenic dyslipidemia, prothrombotic coagulation profile and higher metabolic syndrome prevalence than men with diabetes (Circulation. 2015 Dec 7. doi: 10.1161/CIR.0000000000000343).
Diabetes is also associated with a greater risk of incident heart failure and is a stronger risk factor for stroke in women than in men, although men with stroke are more likely to have diabetes.
Black and Hispanic women with type 2 diabetes also experience a disproportionately larger impact of the disease on their coronary artery disease and stroke risk, compared with men.
The authors of the statement also observed that, compared with men with diabetes, women are less likely to be taking statins, aspirin, ACE inhibitors, or beta-blockers, with the suggestion of lower medication adherence in women.
While the overall prevalence of diabetes is similar in men and women, there are sex-specific conditions such as gestational diabetes and polycystic ovary syndrome that contribute to women’s risk of the disease.
Research is needed to explore the full extent of sex differences between men and women, as this may have therapeutic implications, Dr. Regensteiner said in an interview.
“There really isn’t too much a clinician can do differently at this point because we don’t have information to guide changes in therapy,” she said, noting that any potential heart problems should be subject to the same level of scrutiny in women as in men.
The authors of the statement pointed out that observational evidence suggested women with diabetes may benefit from a higher frequency and intensity of physical activity than men with diabetes, and women with type 1 diabetes may experience greater improvements in hemoglobin A1c with exercise, compared with men.
The American Heart Association issued the statement. Several authors declared research grants or consultancies from the pharmaceutical industry or ownership interests in private companies.