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AHA: Women with type 2 diabetes have higher CHD risk than men
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Among patients with type 2 diabetes, women are twice as likely to have CHD as men, and may require more physical activity to mitigate that risk, according to a scientific statement from the American Heart Association.
“[CVD] may be more deadly for women with type 2 diabetes than it is for men,” Judith G. Regensteiner, PhD, FAHA, professor of medicine and director of the Center for Women’s Health Research at the University of Colorado School of Medicine, Denver, and co-chair of the group that wrote the statement, said in a press release. “While we don’t fully understand how the inherent hormonal differences between men and women affect risk, we do know that some risk factors for heart disease and stroke affect women differently from men and there are disparities in how these risk factors are treated.”
Lifestyle interventions crucial
The writing group noted that “the limited data available suggest that lifestyle interventions may improve [CV] mortality more in women with prediabetes than their male counterparts.”
Prior research has demonstrated that insulin resistance and abdominal adiposity predict CV events in women with prediabetes, which could be related to findings that the Da Qing intervention was more successful in women with prediabetes than in men, and to findings from observational studies that women with diabetes appear to require a higher level of frequency and intensity of physical activity compared with men with diabetes to reduce CV events, they wrote.
“From a practical standpoint, at least 2 hours/week of activity was associated with lower [CV] events for women with [type 2 diabetes] in the Nurses’ Health Study cohort, and this findings is consistent with U.S. physical activity guidelines and the joint American Diabetes Association/American College of Sports Medicine guidelines for people with [diabetes], which recommend at least 150 minutes of weekly physical activity for all adults,” Regensteiner and colleagues wrote.
Less treatment, worse consequences
Compared with men with diabetes, women with diabetes are more likely to have MI at an early age, more likely to die after a first MI, less likely to undergo angioplasty and stenting, less likely to be on statin therapy or other lipid-lowering agents, less likely to have blood glucose or BP controlled, less likely to be on BP medication and less likely to be on aspirin, they wrote.
The disparities are even more exaggerated for black and Hispanic women, they wrote.
“To improve health equity in women and men with diabetes, we need to understand and improve both the biological reasons for the disparities and also control [CV] risk factors equally in both women and men,” Regensteiner said in the release. “This statement is a call for action to do the compelling research that is so important for all people with diabetes.” – by Erik Swain
Disclosure: Regensteiner reports receiving research grants from the ADA, Merck and the NIH. See the full statement for a list of the relevant financial disclosures of the other authors and reviewers.
Perspective
Back to TopGina Lundberg, MD, FACC
This is a very extensive review of CVD in women with diabetes. It reviews what we know and, more importantly, highlights what we don't know and what still needs to be done.
We know that diabetes in women has much greater risk for CVD than it does in men. We need to be better at preventing diabetes in women and therefore need better ways to determine the woman who is at high risk. More focus on preventing diabetes in women with a history of polycystic ovary syndrome and gestational diabetes is emphasized. Also, encouraging healthy lifestyles with weight loss in women with obesity, particularly central obesity, may prevent diabetes in these women.
Women with diabetes need more aggressive medical treatment with appropriate use of statins, aspirin therapy, and also appropriate hypertension treatment. Women with diabetes need to be assessed for peripheral artery disease as well as CVD and stroke risk.
The paper suggests that we start to look at racial and ethnic disparities as well as sex disparities in CVD in diabetes going forward. I think it is a great road map for where we have been, but importantly, shows how far we have yet to go for the optimal treatment for women to prevent diabetes and CVD.
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Regensteiner JG, et al. Circulation. 2015;doi:10.1161/CIR.0000000000000343.
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