TY - JOUR
T1 - Sex differences in diabetes and risk of incident coronary artery disease in healthy young and middle-Aged adults
AU - Kalyani, Rita Rastogi
AU - Lazo-Elizondo, Mariana
AU - Ouyang, Pamela
AU - Turkbey, Evrim
AU - Chevalier, Karinne
AU - Brancati, Frederick Louis
AU - Becker, Diane M
AU - Vaidya, Dhananjay
PY - 2014/3
Y1 - 2014/3
N2 - OBJECTIVE Controversy 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 METHODS We examined subjects aged >60 years without CAD at enrollment in the high-risk GeneSTAR Study (n = 1,448; follow-up 12 years), Multi-Ethnic Study of Atherosclerosis (MESA; n = 3,072; follow-up7 years), and National Health and Nutrition Examination Survey III (NHANES III) Mortality Follow-up Study (n = 6,997; followup 15 years). Diabetes was defined by report, hypoglycemic use, and/or fasting glucose ≤126mg/dL. The outcome was any CAD event during follow-up (fatal CAD in NHANES). RESULTS In 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 cholesterollowering 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. CONCLUSIONS Though 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.
AB - OBJECTIVE Controversy 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 METHODS We examined subjects aged >60 years without CAD at enrollment in the high-risk GeneSTAR Study (n = 1,448; follow-up 12 years), Multi-Ethnic Study of Atherosclerosis (MESA; n = 3,072; follow-up7 years), and National Health and Nutrition Examination Survey III (NHANES III) Mortality Follow-up Study (n = 6,997; followup 15 years). Diabetes was defined by report, hypoglycemic use, and/or fasting glucose ≤126mg/dL. The outcome was any CAD event during follow-up (fatal CAD in NHANES). RESULTS In 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 cholesterollowering 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. CONCLUSIONS Though 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.
UR - http://www.scopus.com/inward/record.url?scp=84896715351&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84896715351&partnerID=8YFLogxK
U2 - 10.2337/dc13-1755
DO - 10.2337/dc13-1755
M3 - Article
C2 - 24178997
AN - SCOPUS:84896715351
SN - 0149-5992
VL - 37
SP - 830
EP - 838
JO - Diabetes care
JF - Diabetes care
IS - 3
ER -