Diabetes Mellitus and Cardiovascular Disease in Women

Sowers, James R.

doi:10.1001/archinte.158.6.617

Cited by 248 publications

(147 citation statements)

References 71 publications

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“…[2][3][4][5][6][7][8][9]21) Another possible explanation for this increased mortality is that younger women had more risk factors for coronary artery disease than did younger men and were more likely to have a history of congestive heart failure and a higher Killip class on presentation. Of special importance is a significantly higher risk of diabetes in women, which has been shown to be an independent poor prognostic factor in patients with AMI [26][27][28] Other possible explanations include sex differences in the pathophysiology of coronary artery disease 29) or differences in thrombotic and fibrinolytic activity. 30) Finally, population based registries of AMI suggest that the differences observed in case fatality between hospitalised women and men are balanced by a larger pre-hospital case fatality rate in men.…”

Section: Discussionmentioning

confidence: 99%

Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Zubaid

Rashed²,

Thalib

et al. 2001

Jpn Heart J

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SUMMARYThere is evidence for gender differences in the treatment and outcome of acute myocardial infarction (AMI). However, little data exist about these differences in patients from the Arab Middle East. Therefore, we studied the influence of patient gender on the presentation, the use of thrombolytic therapy, and in-hospital mortality after AMI in Kuwaiti nationals. This is a retrospective study of all consecutive Kuwaiti patients admitted to the coronary care unit of a university hospital with the diagnosis of AMI between June 1994 and May 1997. A total of 89 women and 267 men were included. Women were older than men and had significantly higher rates of diabetes (72% vs 46%), hypertension (58% vs 33%) and hypercholesterolemia (80% vs 53%). Women were less likely to receive thrombolytic therapy (40% vs 62%, p=0.001). Fewer women were eligible for thrombolytic therapy (50% vs 66%, p<0.05). Of those who were eligible for thrombolysis there was no sex difference in receiving such treatment. The in-hospital mortality among women younger than 70 years was 2.5 times higher than among men in the same age group; while there was no difference in mortality between women and men aged 70 years and older. We conclude that women and men with AMI have different clinical characteristics and outcomes following AMI. There was no gender bias for the use of thrombolytic therapy. The higher in-hospital mortality in younger women, i.e. less than 70 years, compared to younger men, indicates that younger women with AMI should be considered as a high-risk group. (Jpn Heart J 2001; 42: 669-676) Key words: Myocardial infarction, Gender, Thrombolytic therapy, Outcome, Middle East HEART disease is a leading cause of death in Kuwait. In 1995, coronary artery disease was responsible for 15.4% of all deaths among Kuwaitis and 23.6% of all deaths among expatriates. 1) Although coronary artery disease is more prevalent in men, it is the leading cause of death in women as in men. Several studies have assessed sex-based differences in treatment and mortality following AMI. It has From the

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Section: Discussionmentioning

confidence: 99%

Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Zubaid

Rashed²,

Thalib

et al. 2001

Jpn Heart J

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“…However, diabetes mellitus appears to reduce or even obviate the relative protection against IHD conferred by female gender [4][5][6]. Accordingly, diabetes is a stronger risk factor for women than men and, in a recent meta-analysis, Huxley et al (2006) [7] found that the relative risk of fatal coronary heart disease associated with diabetes was about 50% higher in women than men.…”

Section: Introductionmentioning

confidence: 99%

Age and gender differences in the impact of diabetes on the prevalence of ischemic heart disease: a population-based register study

Wiréhn

Östgren

Carstensen

2008

Diabetes Research and Clinical Practice

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Objective: To explore age and gender differences in the impact of diabetes on the prevalence of ischemic heart disease (IHD) in a defined population. Results: In the 45-54 year-old age group, diabetes was associated with an increase in IHD prevalence equivalent to ageing about 20 years in women and 10 years in men. The diabetes/nondiabetes IHD prevalence rate ratio (IPR) decreased with age in both men and women (trend p-values < 0.001). The IPR was higher among women than men in each age group, though the female relative excess decreased from 75% higher in the 45-54 year-old age group to 33% higher in the 65-74 year-old age group (trend p-value = 0.018). Conclusions:The relative gender difference in the impact of diabetes on IHD in younger middle-aged patients remained up to the age of 65 years, decreasing considerably thereafter.

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“…In general, while difference in cardiac rhythm and arrhyathmia exists between genders, premenopausal women are much less susceptible to heart failure, and display much more favorable myocardial adaptation to hemodynamic overload both in contractile function and hypertrophic reserve (8)(9)(10)(11)(12)(13)(14). However, this ''gender-bias'' or ''female advantage'' may be significantly dampened with the onset of diabetes in pre-menopausal women (15). The coronary heart disease-related mortality is approximately five times higher in diabetic than non-diabetic women, compared to a 2-fold difference in age-matched male counterparts (15,16).…”

Section: Introductionmentioning

confidence: 99%

“…However, this ''gender-bias'' or ''female advantage'' may be significantly dampened with the onset of diabetes in pre-menopausal women (15). The coronary heart disease-related mortality is approximately five times higher in diabetic than non-diabetic women, compared to a 2-fold difference in age-matched male counterparts (15,16). Nevertheless, the gender-specific difference in diabetic cardiomyopathy, especially at the single myocyte levels, still remains undefined.…”

Section: Introductionmentioning

confidence: 99%

Influence of Gender on Intrinsic Contractile Properties of Isolated Ventricular Myocytes from Calmodulin‐Induced Diabetic Transgenic Mice

Zhang

Duan

et al. 2003

Endocrine Research

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Diabetes mellitus impairs ventricular function, which itself may be disparately influenced by gender. This study compared the impact of gender on cardiac contractile response in ventricular myocytes from wild-type FVB and calmodulin-induced diabetic transgenic (OVE26) mice at young (2 month) and older (11 month) age. Mechanical and intracellular Ca 2þ properties of cardiac myocytes were evaluated using an IonOptix MyoCam 1 system. Diabetic mice of both genders exhibited significantly elevated blood glucose regardless of age. OVE26 myocytes displayed reduced peak shortening (PS) and maximal velocity of shortening=relengthening (AEdL=dt), and prolonged time-to-PS (TPS) and time-to-90% relengthening (TR 90 ), associated with higher resting intracellular Ca 2þ levels and attenuated Ca 2þ -induced intracellular Ca 2þ release compared with the FVB myocytes. Peak shortening and AEdL=dt were smaller in female FVB groups when compared to the age-matched male counterparts. However, these gender differences were ablated by the diabetic state. No significant gender-related differences in intracellular Ca 2þ handling were noted in either FVB or OVE26 myocytes, with the exception of overt gender differences in OVE26 mice when age was taken into account. Young female OVE26 mice exhibited better-preserved mechanical function while older female OVE26 mice displayed the worst mechanical function among all four OVE26 groups. In conclusion, our data confirmed impaired cardiac contractile function in diabetes, partially due to altered intracellular Ca 2þ handling, in both genders. Mechanical differences existed between genders but were ''cancelled off'' by diabetic state. Nevertheless, a ''female advantage'' in ventricular function may still persist in young female diabetic subjects.

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Diabetes Mellitus and Cardiovascular Disease in Women

Abstract: Diabetes appears to obviate the protective effects of female sex hormones. Possible reasons for this catastrophic effect of diabetes in women are discussed.

Cited by 248 publications

References 71 publications

Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Age and gender differences in the impact of diabetes on the prevalence of ischemic heart disease: a population-based register study

Influence of Gender on Intrinsic Contractile Properties of Isolated Ventricular Myocytes from Calmodulin‐Induced Diabetic Transgenic Mice

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