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Sex Differences in Diabetes and Risk of Incident Coronary Artery Disease in Healthy Young and Middle-Aged Adults
Journal article   Open access   Peer reviewed

Sex Differences in Diabetes and Risk of Incident Coronary Artery Disease in Healthy Young and Middle-Aged Adults

Rita Rastogi Kalyani, Mariana Lazo, Pamela Ouyang, Evrim Turkbey, Karinne Chevalier, Frederick Brancati, Diane Becker and Dhananjay Vaidya
Diabetes care, v 37(3), pp 830-838
01 Mar 2014
DOI: https://doi.org/10.2337/dc13-1755
PMID: 24178997
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.2337/dc13-1755View
Published, Version of Record (VoR) Open

Abstract

Endocrinology & Metabolism Life Sciences & Biomedicine Science & Technology
OBJECTIVEControversy exists about the coronary artery disease (CAD) risk conveyed by diabetes in young and middle-aged women. We investigated sex differences in CAD by diabetes status among healthy individuals with different underlying risks of heart disease.RESEARCH DESIGN AND METHODSWe examined subjects aged <60 years without CAD at enrollment in the high-risk GeneSTAR Study (n = 1,448; follow-up approximate to 12 years), Multi-Ethnic Study of Atherosclerosis (MESA; n = 3,072; follow-up approximate to 7 years), and National Health and Nutrition Examination Survey III (NHANES III) Mortality Follow-up Study (n = 6,997; follow-up approximate to 15 years). Diabetes was defined by report, hypoglycemic use, and/or fasting glucose 126 mg/dL. The outcome was any CAD event during follow-up (fatal CAD in NHANES).RESULTSIn the absence of diabetes, CAD rates were lower among women in GeneSTAR, MESA, and NHANES (4.27, 1.66, and 0.40/1,000 person-years, respectively) versus men (11.22, 5.64, and 0.88/1,000 person-years); log-rank P < 0.001 (GeneSTAR/MESA) and P = 0.07 (NHANES). In the presence of diabetes, CAD event rates were similar among women (17.65, 7.34, and 2.37/1,000 person-years) versus men (12.86, 9.71, and 1.83/1,000 person-years); all log-rank P values > 0.05. Adjusting for demographics, diabetes was associated with a significant four- to fivefold higher CAD rate among women in each cohort, without differences in men. In meta-analyses of three cohorts, additionally adjusted for BMI, smoking, hypertension, HDL, and non-HDL cholesterol, antihypertensive and cholesterol-lowering medication use, the hazard ratio of CAD in men versus women among nondiabetes was 2.43 (1.76-3.35) and diabetes was 0.89 (0.43-1.83); P = 0.013 interaction by diabetes status.CONCLUSIONSThough young and middle-aged women are less likely to develop CAD in the absence of diabetes, the presence of diabetes equalizes the risk by sex. Our findings support aggressive CAD prevention strategies in women with diabetes and at similar levels to those that exist in men.

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112 citations in Web of Science
110 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Endocrinology & Metabolism
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