Women with prediabetes may benefit from earlier intervention to prevent CVD
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Key takeaways:
- Women vs. men with prediabetes had higher levels of biomarkers for inflammation, heart failure and adiposity.
- Earlier use of targeted therapies may benefit women with prediabetes.
Compared with men, women with prediabetes may benefit from earlier intervention to prevent cardiovascular disease, according to a presenter at the World Congress Insulin Resistance Diabetes & Cardiovascular Disease Conference.
“We recognize that women have cardiovascular disease that presents and expresses itself very different in the late stages, but what is less well recognized is that this comes on very gradually over many years and maybe the time for intervention is much earlier, maybe at the stage of prediabetes or even before that, as opposed to waiting until women present with diabetes, or sometimes with cardiovascular disease with undiagnosed diabetes, where the expression is already pretty severe,” Vivian A. Fonseca, MD, FRCP, professor of medicine, assistant dean for clinical research, Tullis-Tulane Alumni Chair in Diabetes and chief of the section of endocrinology and metabolism at the School of Medicine at Tulane University, said during a presentation.
Women with diabetes have a 50% higher risk for CVD compared with men with diabetes, according to Fonseca. Women’s metabolic profile becomes abnormal prior to diabetes onset, particularly with more abdominal fat, hypertension and dyslipidemia, Fonseca said.
Fonseca and colleagues evaluated data from 15,028 adults from the Atherosclerosis Risk in Community Study and 6,814 adults from the Jackson Heart Study. The researchers identified men (n = 3,035; mean age 54.1 years) and women (n = 2,730; mean age, 54.3 years) with prediabetes who were CVD-free. Using multivariable linear regression models, the researchers assessed various biomarkers by sex looking at lipids, inflammation, cardiomyocytes, markers of stress, kidney function and insulin sensitivity, among others. They also adjusted for the presence or absence of menopause with pre- and postmenopausal women age matched with men.
The following median inflammation markers were worse among women compared with men:
- C-reactive protein (3 mg/L vs. 1.7 mg/L);
- fibrinogen (303 mg/L vs. 386 mg/dL);
- N-terminal pro-B-type natriuretic peptide (60.4 pg/mL vs. 35.2 pg/mL);
- insulin resistance (homeostatic model assessment of insulin resistance, 3.1 vs. 2.9);
- adiponectin (4,210 ng/mL vs. 2,834 ng/mL); and
- subcutaneous fat distribution (2,679 cm3 vs. 1,600 cm3).
“Biomarkers of inflammation, heart failure and adiposity are higher in women at this stage of prediabetes telling us that there's a difference between the two groups very early and maybe we should be targeting therapies early that are different in men and women,” Fonseca said.
According to Fonseca, one example would be using anti-inflammatory therapies, which are currently used late in atherosclerotic disease, earlier and evaluating heart failure in prediabetes much earlier in women.
“We want to develop clinical trials that will address these risk factors very early and see what impact these precise targeted interventions will have to improve outcomes with a bit more precision than just giving both men and women the same approach,” Fonseca said. “Our next step is to look at the metabolomic and proteomic profiles comparing men and women during the prediabetes stage and looking at which biological pathways we can identify as targets for these.”
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Fonseca V, et al. Sex differences in cardiovascular risk associated with prediabetes, newly diagnosed diabetes and undiagnosed diabetes. Presented at: World Congress Insulin Resistance Diabetes & Cardiovascular Disease Conference; Dec. 7-9, 2023; Los Angeles.
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