Key result
In type 1 diabetes, each 5-mmHg increase in longitudinal SBP was associated with MACE in men (HR 1.23; 95% CI 1.04-1.45), whereas DBP was associated with hard CAD in women (HR 1.28).
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Why the study?
The authors sought to examine sex differences in longitudinal blood pressure and long-term cardiovascular disease incidence in individuals with type 1 diabetes.
Does the association between longitudinal blood pressure trajectories and cardiovascular disease incidence differ by sex in patients with type 1 diabetes?
Cohort (n=604)
Does the association between longitudinal blood pressure trajectories and cardiovascular disease incidence differ by sex in patients with type 1 diabetes?
In patients with type 1 diabetes, longitudinal blood pressure is lower in women than men, but the association between blood pressure increments and specific cardiovascular outcomes differs significantly by sex.
OBJECTIVE: We examined sex differences in longitudinal blood pressure (BP) and 32-year cardiovascular disease (CVD) incidence in the Pittsburgh Epidemiology of Diabetes Complications type 1 diabetes cohort. RESEARCH DESIGN AND METHODS: BP was measured up to nine (median six) times between 1986-1988 baseline and 2016-2018; n = 300 women and 304 men without CVD at baseline were followed until December 2020 for incidence of total CVD, major adverse cardiovascular events (MACE) (CVD death, myocardial infarction [MI], or stroke), and hard coronary artery disease (hCAD) (CAD death, MI, or coronary revascularization/blockage ≥ 50%). We estimated associations between time to event and longitudinal systolic BP (SBP) and diastolic BP (DBP) by sex using joint models adjusted for time-varying longitudinal antihypertensive (AH) medication use, HbA1c, and overt nephropathy, baseline age, and other CVD risk factors. RESULTS: Longitudinal SBP was 5.8 mmHg lower (P < 0.0001) and DBP 6.2 mmHg lower (P < 0.0001) in women versus men. Women had -0.3 mmHg/year faster DBP decline (P < 0.0001) despite similar AH rates by sex. Incidence of CVD was similar by sex. Each 5-mmHg increment in longitudinal SBP (hazard ratio [HR] = 1.23; 95% CI 1.04, 1.45) and DBP (HR = 1.56; 95% CI 1.20, 2.04) was associated with MACE in men only; DBP (HR = 1.28; 95% CI 1.05, 1.56) was associated with hCAD in women only. CONCLUSIONS: BP was lower in women than men, and the strength of its association with the initial manifestation of CVD differed by sex. Further research into sex-specific BP mechanisms is needed to improve CVD risk reduction in people living with type 1 diabetes.
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Miller et al. (2025) conducted a cohort in Type 1 diabetes (n=604). Longitudinal blood pressure vs. Sex differences was evaluated on Incidence of total CVD, major adverse cardiovascular events (MACE), and hard coronary artery disease (hCAD) (HR 1.23, 95% CI 1.04-1.45). In type 1 diabetes, each 5-mmHg increase in longitudinal SBP was associated with MACE in men (HR 1.23; 95% CI 1.04-1.45), whereas DBP was associated with hard CAD in women (HR 1.28).
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