Sex differences in cardiovascular risk factors before and after the development of type 2 diabetes and risk for incident cardiovascular disease

Michael P. Bancks, Ehimare Akhabue, Jamal S. Rana, Jared P. Reis, Pamela J. Schreiner, Yuichiro Yano, Cora E. Lewis

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: To assess sex differences in cardiovascular (CVD) risk factor changes before and after the development of type 2 diabetes, and, the association between incident diabetes with incident CVD in mid-life. Methods: We included 4893 Coronary Artery Risk Development in Young Adults Study participants, age 18–30 years at enrollment (1985–86). We ascertained incident diabetes and assessed sex differences in annual change in body mass index, blood pressure, and lipids before and after the ascertainment of diabetes using piecewise linear regression. We examined sex differences in the association between incident diabetes with incident CVD over 31 years of median follow-up. Results: Progression in most CVD risk factors did not differ by sex before diabetes. Women had better CVD profiles at the time of diabetes compared to men, and after diabetes, women had worse annual changes in blood pressure and lipids. Incident diabetes was associated with a higher hazard for incident CVD (Hazard Ratio [HR]: 1.45, 95% confidence limits: 1.07, 1.96) and we did not observe effect modification by sex (p for interaction = 0.8). Conclusions: CVD risk factors worsened more rapidly after the development of type 2 diabetes for women than men. However, diabetes was not a stronger risk factor for incident CVD for women than men.

Original languageEnglish (US)
Article number108334
JournalDiabetes Research and Clinical Practice
Volume166
DOIs
StatePublished - Aug 2020

Bibliographical note

Funding Information:
The authors thank the other investigators, the staff, and the participants of the CARDIA study for their valuable contributions. The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham ( HHSN268201800005I & HHSN268201800007I ), Northwestern University ( HHSN268201800003I ), University of Minnesota ( HHSN268201800006I ), and Kaiser Foundation Research Institute ( HHSN268201800004I ). Dr. Bancks is the guarantor of this work. As such, he takes responsibility for the integrity of the data and the accuracy of the data analysis and affirms that the manuscript is an honest, accurate, and transparent account of the study being reported. All co-authors: Drs. Bancks, Akhabue, Rana, Reis, Schreiner, Yano, and Lewis contributed to the acquisition, analysis, or interpretation of data; provided critical revision of the manuscript for important intellectual content and contributed to the discussion; and approve the final version of this report for publication. The datasets analyzed during the current study are not publicly available due to the possibility that some information in these data might compromise research participants’ privacy or consent. However, data and code to reproduce the results are available from the corresponding author on request and de-identified data through CARDIA examination year 25 are publically available at: https://biolincc.nhlbi.nih.gov/studies/cardia/ .

Keywords

  • Cardiovascular disease
  • Cardiovascular risk factors
  • Diabetes
  • Incidence
  • Sex differences
  • Young adulthood

PubMed: MeSH publication types

  • Journal Article

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