Excess Cardiovascular Risk in Diabetic Women A Ca

Authors: C Recarti S J S Sep C D A Stehouwer T Unger

Publish Date: 2015/04/24

Volume: 17, Issue: 6, Pages: 45-

PDF Link

Abstract

Diabetes is a common and rapidly growing disease that affects more than 380 million people worldwide and is an established risk factor for cardiovascular disease with differential effects on women compared to men While the general population of women particularly young women has more favourable cardiovascular risk profiles than men this protective effect has been shown to be lost or even reversed in diabetic women Several studies have demonstrated a significant diabetesassociated excess risk of cardiovascular disease in women Sexspecific differences in risk factors associated with diabetes and their management may be responsible for the relative excess cardiovascular risk in women with diabetes Diabetic women need intensive treatment in order to optimize management of cardiovascular risk factors Further studies are needed to elucidate the mechanisms underlying the excess cardiovascular risk in diabetic women in order to tailor prevention and treatment strategiesDiabetes is a common and rapidly growing disease 1 The International Diabetes Federation has projected that the number of people with diabetes in the world will increase from 387 million in 2014 to 592 million by 2035 2 The World Health Organization WHO reported a global prevalence of 9  in 2014 3 There are two main forms of diabetes Type 1 diabetes is due primarily to autoimmunemediated destruction of pancreatic betacells resulting in insulin deficiency Type 2 diabetes is characterized by insulin resistance and abnormal insulin secretion and accounts for 85–95  of diabetes cases globally 4• Both types of diabetes are on the increase type 2 diabetes in particularIndividuals with diabetes have an increased risk of developing a number of disabling and lifethreatening health problems including serious diseases affecting the cardiovascular system eyes kidneys and nerves Evidence for an excess risk of cardiovascular disease associated with diabetes in women is increasing an observation that urges intensified treatment and management of female diabetes patients This review summarizes the evidence of sex differences in diabetesassociated risk of cardiovascular disease and provides possible explanations for the excess risk in women that may provide femalespecific targets for prevention and treatment It also highlights the importance of sexspecific analysis in trials and observational studies of treatment and control of cardiovascular risk factors in persons with diabetes and gives recommendations for future researchType 1 diabetes occurs predominantly in children and young adults Incidence rates vary widely and range from 01/100000 per year in Chinese regions to more than 40/100000 per year in Finland 5 Agespecific incidence rates do not differ between the sexes up to 14 years of age in most studies 6 However at older ages male excess is a constant finding in populations of European origin 7 8 9 10Type 2 diabetes is a multifactorial and heterogeneous disease It is often a manifestation of clustering of disorders including hyperinsulinaemia dyslipidaemia hypertension visceral obesity hypercoagulability and microalbuminuria The diabetes epidemic and the potential for increases in numbers of cases although apparent around the world are most pronounced in nonCaucasian populations 11 The global prevalence of diabetes was 8  in 2013 and reached 35  in some regions 4 Overall there is little sex difference in the global numbers of people with type 2 diabetes The prevalence rises with age and is slightly higher in men up to the age of 70 4 The global prevalence in men 50 years of age was about 15  compared to 13  in their female counterparts Due to the long time period that frequently elapses before diabetes is detected a substantial number of cases may be undiagnosed

Keywords: