TY - JOUR
T1 - Sex differences in coronary artery calcium and mortality from coronary heart disease, cardiovascular disease, and all causes in adults with diabetes
T2 - The coronary calcium consortium
AU - Wong, Nathan D.
AU - Hsu, Amber R.Cordola
AU - Rozanski, Alan
AU - Shaw, Leslee J.
AU - Whelton, Seamus P.
AU - Budoff, Matthew J.
AU - Nasir, Khurram
AU - Miedema, Michael D.
AU - Rumberger, John
AU - Blaha, Michael J.
AU - Berman, Daniel S.
N1 - Publisher Copyright:
© 2020 by the American Diabetes Association.
PY - 2020/10
Y1 - 2020/10
N2 - OBJECTIVE While diabetes has been previously noted to be a stronger risk factor for cardiovascular disease (CVD) in women compared with men, whether this is still the case is not clear. Coronary artery calcium (CAC) predicts coronary heart disease (CHD) and CVD in people with diabetes; however, its sex-specific impactislessdefined. We compared the relation of CAC in women versus men with diabetes for total, CVD, and CHD mortality. RESEARCH DESIGN AND METHODS We studied adults with diabetes from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality end points. RESULTS Among 4,503 adults with diabetes (32.5% women) aged 21–93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age-and risk factor–adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P 5 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P 5 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101–400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P 5 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P 5 0.01). CONCLUSIONS CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.
AB - OBJECTIVE While diabetes has been previously noted to be a stronger risk factor for cardiovascular disease (CVD) in women compared with men, whether this is still the case is not clear. Coronary artery calcium (CAC) predicts coronary heart disease (CHD) and CVD in people with diabetes; however, its sex-specific impactislessdefined. We compared the relation of CAC in women versus men with diabetes for total, CVD, and CHD mortality. RESEARCH DESIGN AND METHODS We studied adults with diabetes from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality end points. RESULTS Among 4,503 adults with diabetes (32.5% women) aged 21–93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age-and risk factor–adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P 5 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P 5 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101–400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P 5 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P 5 0.01). CONCLUSIONS CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.
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U2 - 10.2337/dc20-0166
DO - 10.2337/dc20-0166
M3 - Article
C2 - 32816996
AN - SCOPUS:85091469728
SN - 0149-5992
VL - 43
SP - 2597
EP - 2606
JO - Diabetes care
JF - Diabetes care
IS - 10
ER -