NEW ORLEANS – Premenopausal women with type 1 diabetes mellitus have a higher cardiovascular risk, compared with their diabetes-free counterparts. Among postmenopausal women, however, those with type 1 diabetes do not have a higher cardiovascular risk, compared with their peers who do not have diabetes, with the exception of those aged 54 and older.
Those are key findings from an analysis of women enrolled in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study.
Doug Brunk/Frontline Medical News
Amena Keshawarz
“In general [premenopausal] women have a better cardiovascular profile than do men, but we don’t see that same effect in diabetic women,” lead author Amena Keshawarz said in an interview in advance of the annual scientific sessions of the American Diabetes Association. “They lose some of that protection. We’re wondering if that has some sort of relationship with menopause, because once women undergo menopause they tend to lose that protective factor.”
Ms. Keshawarz, a doctoral student and research assistant at the University of Colorado Barbara Davis Center for Childhood Diabetes, Aurora, and her associates used carotid intima-media thickness (cIMT) and the presence of coronary artery calcification to measure the cardiovascular risk by menopausal status in 106 women with type 1 diabetes and 140 nondiabetic women who were enrolled in CACTI. The patients ranged in age from 33-74 years and the data were collected between January 2014 and May 2016. Multivariable linear and logistic regressions were used to examine the differences in cIMT and to estimate the odds ratio for coronary artery calcification (CAC). The models were run for the following ages separately: 42, 42, 48, 51, 54, and 57 years.
As a group, women with type 1 diabetes were younger than their counterparts without diabetes (a mean age of 51 vs. 55 years, respectively; P = .002), but menopause age did not differ by diabetes status. Ms. Keshawarz reported that women with type 1 diabetes had significantly higher age-adjusted odds of significant CAC and higher cIMT, compared with those in the nondiabetic group, but these relationships differed by age and menopause status. For example, among premenopausal women, type 1 diabetes increased the odds of CAC at all ages, and cIMT was higher in women with type 1 diabetes, compared with those in the nondiabetic group at age 45 years and older. Among postmenopausal women, type 1 diabetes was associated with only higher CAC at age 54 years and older and with higher cIMT at age 57 years.
“Type 1 diabetic women face unique problems in their health that are not just endocrinology-related,” Ms. Keshawarz said. “If they haven’t undergone menopause yet, that needs to be taken into account when you’re proposing interventions and lifestyle and behavioral changes, because there is an increased possibility that they’re going to be at higher risk of coronary artery calcification and thicker [coronary] artery walls.”
The study was supported by grants from the American Diabetes Association and the National Institutes of Health. Ms. Keshawarz reported having no financial disclosures.