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Type 2 diabetes increased CHD risk in premenopausal women
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Type 2 diabetes appears to be an independent predictor of increased risk for CHD in premenopausal women, according to findings presented at the American Heart Association High Blood Pressure Research 2013 Scientific Sessions.
Nestor H. Garcia, MD, PhD, and colleagues investigated whether measuring total plaque area in women would allow better early detection of CV events as compared with the Framingham risk score alone.
“Currently, global risk assessment derived by a Framingham risk equation is used to identify women at increased risk, but still we do not detect them early enough to decrease the rate of cardiovascular events,” Garcia, of CONICET, an Argentine governmental agency in Buenos Aires, and colleagues wrote in the study abstract. “Perhaps we overestimate the protection during the premenopausal and early postmenopausal years, and overestimate the sensitivity of risk scores.”
The cross-sectional study included 1,256 women in Argentina aged 19 to 84 years. The researchers assessed total plaque area in the carotid arteries by ultrasound and evaluated participants by Framingham risk score with BMI and by post-test probability with total plaque area. Participants were divided into two groups: those with type 2 diabetes (n=293) and those without diabetes (n=963). The groups were also subdivided by age strata: younger than 40 years, 40 to 50 years, 50 to 60 years, and older than 60 years.
Women with diabetes had higher total plaque area vs. those without diabetes, and higher Framingham risk score with BMI vs. those without diabetes across all age groups. The post-test probability with total plaque area scores were as follows:
- In those younger than 40 years, 10 ± 3 for the diabetes group vs. 3 ± 1 for the control group.
- In those aged 40 to 50 years, 27 ± 4 for the diabetes group vs. 9 ± 1 for the control group.
- In those aged 50 to 60 years, 48 ± 3 for the diabetes group vs. 23 ± 1 for the control group.
- In those older than 60 years, 73 ± 1 for the diabetes group vs. 50 ± 1 for the control group.
“These data indicate that [women with diabetes] in premenopausal or first years of menopausal age (40-50 years) are at intermediate or high risk to develop a cardiovascular event while nondiabetic women reach this … risk after age 50,” the researchers wrote. “Direct assessment of atherosclerotic burden, such as [total plaque area], should be used early in this population, even in the presence of menstrual cycles, instead of relying on traditional risk scores.”
There were no differences between the groups for smoking, hypertension or presence of an early family CV event.
For more information:
Garcia NH. Abstract #614. Presented at: the American Heart Association High Blood Pressure Research 2013 Scientific Sessions; Sept. 11-14, 2013; New Orleans.
Disclosure: The study was funded by Blossom DMO and CONICET. The researchers report no relevant financial disclosures.
Perspective
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Robert H. Eckel, MD
There is nothing really new here, and the findings are perfectly consistent with the literature. The approach to women with type 2 diabetes before menopause, and actually at any age during adult life, should be more aggressive in modifying CVD risk.
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