A study by CERG researchers published in the Scandinavian Cardiovascular Journal shows that both newly diagnosed and known diabetes are associated with fatal coronary artery disease. Moreover, as glucose regulation is increasingly impaired, the cardioprotective effect of gender for females becomes consistently weaker. In other words; diabetes over time is especially bad for women.
(Read a full summary of the article on our website.)
Past studies have shown that women with diabetes have a worse cardiovascular risk profile than men with diabetes, and diabetes is more strongly associated with fatal cardiovascular disease in women. This means that although men overall are at a greater risk of cardiovascular disease, women are at a higher risk of dying from it, once the cardiometabolic risk factors begin to amass. A lot remains unknown about these complex diseases, both in terms of gender differences, and also in how the diseases develop from underlying causes.
The findings of the study are twofold. In addition to the cautionary tale for women to minimize personal risk of diabetes and cardiovascular disease, the study also seeks to address the long-standing question of whether a discernible cardiovascular detriment arises as soon as glucose regulation is impaired, or whether this only manifests at a later stage. This could help shed light on the underlying causes and links between diabetes and cardiovascular disease.
What comes first?
As it stands, it’s a bit of a chicken-or-egg type question; does diabetes lead to dyslipidemia, which in return causes cardiovascular disease, or do vascular changes predispose a person to diabetes and obesity? Perhaps the pathophysiological pathways differ by sex? The question of where genetics and lifestyle intersect may be of equal significance. And perhaps most importantly, the answers to all of these questions influence what constitutes effective and successful patient care. Where on the pathway to disease is it best to intervene?
Although the trend seemed to show that death from coronary artery disease was associated with glucose regulation status, this study did not find a statistically significant association between impaired glucose regulation (IGR) and fatal CAD. Nevertheless, while the overall study sample was 47,951 individuals (23,229 men and 24,722 women) only 365 of these were in the IGR group and in return only 66 in the group died during follow-up, resulting in a small sample size. The authors also recognize misclassification and underreporting of the IGR group as potential limitations of the study, which could have underestimated the effects.
Either way, it is clear that additional research is needed in this field in order to successfully address and treat the current epidemic of lifestyle-related diseases.
Written by Hanna Sofie Ellingsen, at CERG.