Type 2 diabetes and cardiovascular disease in women

Abstract

Cardiovascular disease is the leading cause of death in both men and women. This is also true for patients with diabetes. In general, differences between the sexes are present in several areas, such as epidemiology, pathophysiology, diagnostics, treatment response and prognosis, as well as the way in which disease is experienced and expressed. Cardiovascular disease presents later in life in women, who are therefore more likely to suffer from comorbidities. However, this agerelated difference is attenuated in women with diabetes, who suffer their first myocardial infarction at about the same age as men with diabetes. Diabetes mellitus increases the risk of cardiovascular disease by three to four times in women and two to three times in men, after adjusting for other risk factors. This paper describes the differences in cardiovascular disease in men and women and the special situation of women with type 2 diabetes when it comes to risk factors, symptoms and the setting of acute coronary syndromes. Furthermore, it highlights the importance of sex-specific analyses in clinical research to improve our knowledge of cardiovascular disease in women in general and in women with diabetes in particular. The importance of taking sex into account when treating women and men at risk of cardiovascular disease is discussed. Sex aspects in cardiovascular diseaseDespite a remarkable improvement in life expectancy and a decline in cardiovascular mortality during the last few decades, cardiovascular disease (CVD) is still the leading cause of death in men and women ( Fig. 1) . The major causes of CVD are ischaemic heart disease and stroke. Ageing populations and improved CVD survival will increase morbidity and step up the demands imposed on healthcare systems in the future. CVD has traditionally been perceived as a male illness but, in Europe-with the exceptions of France, the Netherlands and Spain-at least, it ends the lives of as many women as men [2], and worldwide, CVD is the most common cause of death in women in most countries except for Africa, especially above 60 years of age [3]. The ongoing global epidemics of obesity and diabetes will further accelerate this problem [4]. Women's health has traditionally focused on matters related to sexual and reproductive health. The lack of awareness of CVD in women, among both clinicians and women themselves, is especially alarming in countries with low or intermediate incomes, where public-health policy has largely focused on infectious diseases in general and the maternal and reproductive health of women in particular.

Risk Stratification of Coronary Artery Disease in Asymptomatic Diabetic Subjects Using Multidetector Computed Tomography

“…12 The reason for this higher mortality rate in women is multifactorial and related to a higher risk factor burden, more microvascular complications such as neuropathy, retinopathy, and nephropathy, and an often less aggressive treatment of DM in women than in men. 13 However, overall risk factor burden, including microvascular complications and glycemic control, along with risk factors, has not been considered in sex-associated risk stratification.…”

Asociación entre diabetes mellitus y patología cardiovascular en la población adulta de Chile: estudio de la Encuesta Nacional de Salud 2009-2010

“…Posteriormente, numerosos estudios poblacionales de observación han corroborado esta observación [24][25][26][27][28][29][30] .…”

“…De hecho, la presencia de diabetes en mujeres adelanta la edad del primer infarto miocárdico a un rango etario equivalente al de los hombres 30,32 .…”

“…Algunos autores señalan que este fenómeno pudiese depender mayoritariamente de la mayor carga de factores de riesgo cardiovascular en las PD mujeres, ya que las diferencias observadas, en sus estudios, se anulan al corregir por estos factores 30 .…”

“…Otros investigadores postulan que la mayor ECVA en PD mujeres podría atribuirse a variados factores hormonales, tales como el uso de anticoncepción oral, menopausia precoz o aparición del síndrome de ovario poliquístico 30 .…”