Burden of Cardiometabolic Risk Factors Differs Between Women, Men With T1D

Women living with type 1 diabetes (T1D) have a lower burden of cardiometabolic risk factors compared with men with T1D, and women in the general population have a lower absolute risk of cardiovascular disease (CVD).

However, women with T1D do not have a significantly lower CVD event burden than men with T1D, according to research published in JAMA Network Open.

These findings suggest a greater clinical impact of cardiometabolic risk factors in women with T1D compared with their male counterparts, and further stress the need for optimized CVD risk factor management in women with T1D.

“While the protection for CVD in women vs men in the general population is reduced in the presence of diabetes, several studies have found that the absolute risk of CVD remains similar or lower in women with diabetes compared with men with diabetes,” the study authors wrote. “However, several meta-analyses of prospective cohort studies have shown that the relative risk of CVD mortality and morbidity associated with type 2 diabetes is higher in women than in men, suggesting that the increase in risk associated with type 2 diabetes is higher in women than in men.”

To come to these findings, the authors collected data of 680 women and 761 men with T1D enrolled in the combined Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study.

The DCCT randomized clinical trial was conducted between 1983 and 1993, and the EDIC observational study started in 1994 and is ongoing. Data collected by 27 clinical centers in the United States and Canada through April 30, 2018, were included in this study.

Among the 1441 patients with T1D included, the mean (SD) age at DCCT baseline was 26.8 (7.1) years, and the mean follow-up was 28.8 (5.8) years. Nearly all patients (96.5%) were non-Hispanic White, which the authors noted was a major limitation of this study as it limits the generalizability of these findings to other populations.

Throughout the study, women with T1D had significantly lower body mass index (BMI), waist circumference, blood pressure (BP), and triglyceride levels compared with men.

• BMI (β = −0.43 [standard error (SE) 0.16]; P = .006)
• waist circumference (β = −10.56 cm [SE, 0.52 cm]; P < .001)
• BP (systolic: β = −5.77 mm Hg [SE, 0.35 mm Hg]; P < .001; diastolic: β = −3.23 mm Hg [SE, 0.26 mm Hg]; P < .001),
• triglyceride levels (β = −10.10 mg/dL [SE, 1.98 mg/dL]; P < .001)

Women with T1D also had higher levels of high-density lipoprotein (HDL) cholesterol (β = 9.36 mg/dL [SE, 0.57 mg/dL]; P < .001) and similar levels of low-density lipoprotein (LDL) cholesterol (β = −0.76 mg/dL [SE, 1.22 mg/dL]; P = .53) compared with men with T1D. The former is often referred to as “good” cholesterol, as it absorbs cholesterol and carries it back to the liver, while the latter is called “bad” cholesterol because it collects in blood vessels.

Additionally, women with T1D achieved the recommended targets for BP (ie, <130/80 mm Hg: 90.0% vs 77.4%; P < .001) and triglycerides (ie, <150 mg/dL: 97.3% vs 90.5%; P < .001) more frequently than their male counterparts.

At the same time, women achieved sex-specific HDL cholesterol targets—at least 50 mg/dL for women and at least 40 mg/dL for men—less often than men (74.3% vs 86.6%; P < .001). They also achieved targets for tighter glycemic control less often.

Further, women were less likely to use cardioprotective medications, such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or lipid-lowering medications.

Women with T1D also experienced significantly higher pulse rates and hemoglobin A_1c levels.

Unadjusted analyses did not identify a significant difference between women and men in risk of any CVD event (unadjusted HR, 0.81; 95% CI, 0.64-1.04) or a major adverse CV event (unadjusted HR, 0.74; 95% CI, 0.53-1.03). Models adjusting separately for risk factors revealed that adjusting for pulse rate yielded a decreased risk of any CVD event and of a major CV event among women.

“Our findings argue for a recalibration of CVD risk factor stratification in revised clinical care guidelines and therapeutic recommendations by sex for individuals with type 1 diabetes,” the authors concluded. “The need for conscientious optimization of the control of comorbid risk factors in women with diabetes cannot be overstated.”

Reference

Braffett BH, Bebu I, El ghormli L, et al. Cardiometabolic risk factors and incident cardiovascular disease events in women vs men with type 1 diabetes. JAMA Netw Open. 2022;5(9):e2230710. doi:10.1001/jamanetworkopen.2022.30710