Key result
Female sex linked to ~5 mg/dL greater HDL-C increase post-acute stress vs men.
Why the study?
The mechanism and regulation of the gender gap in HDL-C, including its maintenance during acute stress in diabetic patients, is not well understood.
Observational (n=179)
Acute metabolic decompensation transiently abolishes the HDL-C gender gap in diabetes; leaves open whether recurrent stress cumulatively erodes women's lipid advantage.
CONTEXT: The gender gap in high-density lipoprotein cholesterol (HDL-C) is well documented in health and also maintained in diverse chronic conditions, including menopause and diabetes. The mechanism for this difference in HDL-C and its regulation is not well understood. We evaluated whether this gender gap is maintained during acute stress. SETTING AND DESIGN: Diabetic patients with metabolic decompensation (n=179) were studied in the fasting state within 24 hours of admission to hospital, and again at outpatient follow-up. Fasting lipids and measures of glycemic control were evaluated on both occasions. The population was predominately minority, 78% Hispanic or African American. RESULTS: During admission, fasting lipid concentrations were not different in women (W) (n = 88) and men (M) (n = 91); serum total cholesterol (total-C), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and HDL-C were similar. Glycemic control was also similar; hemoglobin A1c (A1C) and serum glucose at presentation to hospital were not different in men and women. Compared with a subset of patients with pre-admission data (W, 35; M, 24), a decline of HDL-C was observed, greater in women (P = .005). At outpatient follow-up after admission, median duration approximately 4 months in each group (P = .39), changes in TG, LDL-C, and total-C from baseline admission were not different in men and women. In contrast, whereas HDL-C increased in both groups, the increase (median [interquartile range]) was significantly greater in women, 11 (4, 23) vs 6 (-1, 15) mg/dL (P < .003). This larger increase restored the gender gap in fasting HDL-C, 48 (39, 61) and 41 (36, 49) mg/dL in women and men at follow-up (P < .002). A1C improved similarly in each group. CONCLUSIONS: The sex difference in HDL-C levels is lost at time of admission to hospital in patients with diabetes, and returns when acute stress has resolved. These results raise the possibility that recurrent episodes of acute stress may lead to cumulative loss of the HDL-C advantage in women.
No takes yet. Share an insight, caveat, or question.
Djekic et al. (2014) conducted an observational in Diabetic patients with metabolic decompensation (acute stress) (n=179). Female sex vs. Male sex was evaluated on Increase in HDL-C from hospital admission to outpatient follow-up (median mg/dL) (p=<0.003). Female sex was associated with a greater increase in HDL-C following resolution of acute stress compared to men (11 vs 6 mg/dL; P<0.003), restoring the gender gap lost at hospital admission.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: