What is the clinical evidence from this study?

Study design: Cohort. Population: Healthy young and middle-aged adults (n=11517). Intervention: Male sex vs. Female sex. Primary outcome: Any CAD event during follow-up (fatal CAD in NHANES) (HR 0.89, 95% CI 0.43-1.83, p=0.013 for interaction).

November 1, 2013Open Access

Sex Differences in Diabetes and Risk of Incident Coronary Artery Disease in Healthy Young and Middle-Aged Adults

Key Result

In young and middle-aged adults, the presence of diabetes equalizes the risk of incident CAD between men and women (HR 0.89; 95% CI 0.43-1.83), whereas men have a higher risk without diabetes.

Study Design

Type

Cohort (n=11,517)

Multicenter

Yes

Structured PICO

Does the presence of diabetes alter the sex differences in incident coronary artery disease risk among healthy young and middle-aged adults?

Population

11,517 adults aged <60 years without coronary artery disease at baseline, followed for 7 to 15 years across three cohorts.

Exposure

Presence of diabetes (defined by report, hypoglycemic use, and/or fasting glucose ≥126 mg/dL)

Comparator

Absence of diabetes

Outcome

Any CAD event during follow-up (fatal CAD in NHANES)hard clinical

While young and middle-aged women have a lower risk of CAD than men in the absence of diabetes, the presence of diabetes equalizes this risk, supporting aggressive CAD prevention strategies in women with diabetes.

Main Result

Hazard Ratio: 0.89 (95% CI 0.43–1.83)

p-value: p=0.013 for interaction

Abstract

OBJECTIVE: Controversy exists about the coronary artery disease (CAD) risk conveyed by diabetes in young and middle-aged women. We investigated sex differences in CAD by diabetes status among healthy individuals with different underlying risks of heart disease. RESEARCH DESIGN AND METHODS: We examined subjects aged 0.05. Adjusting for demographics, diabetes was associated with a significant four- to fivefold higher CAD rate among women in each cohort, without differences in men. In meta-analyses of three cohorts, additionally adjusted for BMI, smoking, hypertension, HDL, and non-HDL cholesterol, antihypertensive and cholesterol-lowering medication use, the hazard ratio of CAD in men versus women among nondiabetes was 2.43 (1.76-3.35) and diabetes was 0.89 (0.43-1.83); P = 0.013 interaction by diabetes status. CONCLUSIONS: Though young and middle-aged women are less likely to develop CAD in the absence of diabetes, the presence of diabetes equalizes the risk by sex. Our findings support aggressive CAD prevention strategies in women with diabetes and at similar levels to those that exist in men.

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