OBJECTIVE -We examined whether biomarkers of endothelial function, fibrinolysis/ thrombosis and adiponectin, predict the progression from normal to pre-diabetes more strongly among women than men over 6 years of follow-up from the Western New York Health Study. participants from the Western New York Health Study, who were free of type 2 diabetes and cardiovascular disease at baseline (1996 -2001), were selected for reexamination. An incident case of pre-diabetes was defined as fasting glucose Ͻ100 mg/dl at the baseline examination and Ն100 and Ͻ126 mg/dl at the follow-up examination. Biomarkers of endothelial function (E-selectin and soluble intracellular adhesion molecule-1 [sICAM-1]), fibrinolysis/thrombosis (plasminogen activator inhibitor-1 [PAI-1]), and fasting insulin, adiponectin, and inflammation (high-sensitivity C-reactive protein) were measured in frozen (Ϫ190°C) baseline samples.
RESEARCH DESIGN AND METHODSRESULTS -Multivariate analyses revealed higher adjusted mean values of biomarkers of endothelial dysfunction (E-selectin and sICAM-1) and fibrinolysis (PAI-1) and lower mean values of adiponectin only among women who developed pre-diabetes compared with control subjects. Formal tests for interaction between sex and case/control status were statistically significant for E-selectin (P ϭ 0.042), PAI-1 (P ϭ 0.001), sICAM-1 (P ϭ 0.011), and frequency of hypertension (P Ͻ 0.001).CONCLUSIONS -These results support the concept that women who progressed from normoglycemia to pre-diabetes have greater endothelial dysfunction than men as well as more hypertension and a greater degree of fibrinolysis/thrombosis. Whether this relates to the higher risk of heart disease among diabetic women awaits further study.
Diabetes Care 30:354 -359, 2007D eath rates from coronary heart disease (CHD) in the U.S. have fallen dramatically over the last several decades; however, the rate of decline has been greater among men than among women (1). The factors underlying this sex difference are unclear (2-6). It has also been suggested that women, especially those with type 2 diabetes, are more likely to have coronary microvascular disease than men (7,8). It is well known that diabetic women have a much higher risk for CHD than their male counterparts, a risk not completely explained by traditional biological and psychosocial factors (9,10).Previous studies have shown that the frequency of nonfatal myocardial infarction is increased before the clinical diagnosis of type 2 diabetes (11) and that women with impaired glucose tolerance tend to have a more atherogenic risk profile than their male counterparts years before the diagnosis of clinical diabetes (12). This observation has led to the "ticking clock" hypothesis (13), wherein the elevated CHD risk among diabetic individuals may be due more to their longstanding atherogenic risk profile than to hyperglycemia per se, which is more strongly associated with the risk of microvascular events (14). Recently, attention has been focused on the role of emerging risk factors including ...