Despite Improved Risk Profiles, Women with Type 1 Diabetes Face Increased CVD Risk

An analysis of data from a pair of landmark diabetes studies is providing insight into the differences in prognostic value of cardiometabolic risk factors for predicting incident cardiovascular disease events among men and women with type 1 diabetes.

Using data from the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC), the investigators’ deep dive produced evidence demonstrating women had a more favorable cardiometabolic risk factor profile and received less aggressive cardioprotective medications, but did not have a significantly lower cardiovascular event burden compared to their male counterparts.

“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 need for conscientious optimization of the control of comorbid risk factors in women with diabetes cannot be overstated,” wrote investigators.

Although mountains of data have been published illustrating and comparing various cardiometabolic risk profiles and their associations with cardiovascular disease in type 2 diabetes, much less data exists related to Cardiometabolic risk factors profiles and risk of cardiovascular disease events among patients with type 1 diabetes. A decade earlier, investigators had performed a similar analysis to that of the current study, which was designed with an interest in exploring temporal trends in sex disparities in cardiovascular risk management among patients with type 1 diabetes. With approximately 29 years of follow-up data in the DCCTR and EDIC studies, investigators hoped to estimate differences in prevalence of cardiometabolic risk factors and their management in association with cardiovascular disease events in women vs men with type 1 diabetes. From the studies, investigators obtained data related to 1441 people with type 1 diabetes who had a mean age of 26.8 (SD, 7.1) years at DCCT baseline. This study cohort was 52.8% men and 96.5% identified as non-Hispanic White.

The primary outcome of interest was defined as time to CVD death or time to the first occurrence of nonfatal myocardial infarction (MI), nonfatal stroke, subclinical MI on electrocardiography, angina confirmed by ischemic changes during exercise tolerance testing or by clinically significant obstruction on coronary angiography, revascularization, or congestive heart failure. Investigators pointed out all cardiovascular disease events were centrally adjudicated by a committee masked to treatment assignment and HbA1c. For the purpose of analysis, linear mixed models and Cox proportional hazards models were used to estimate sex differences in cardiometabolic risk factors and cardiovascular disease risk during the follow-up period.

Upon analysis, investigators found women had significantly lower body mass index (β = −0.43 [SE, 0.16]; P=.006), waist circumference (β = −10.56 cm [SE, 0.52 cm]; P <.001), blood pressure (systolic: β = −5.77 mmHg [SE, 0.35 mmHg]; P <.001; diastolic: β = −3.23 mm Hg [SE, 0.26 mmHg]; P <.001), and triglyceride levels (β = −10.10 mg/dL [SE, 1.98 mg/dL]; P <.001) compared with their male counterparts. Women also had higher HDL-C levels (β = 9.36 mg/dL [SE, 0.57 mg/dL]; P <.001), but similar LDL-C levels (β = −0.76 mg/dL [SE, 1.22 mg/dL]; P=.53) as their male counterparts. When assessing the portion of patients reaching treatment targets, results indicated women achieved recommended targets more frequently for blood pressure (90.0% vs 77.4%; P <.001) and triglycerides (97.3% vs 90.5%; P <.001). However, results indicated sex-specific HDL cholesterol targets were achieved less often (74.3% vs 86.6%; P <.001) by women than their male counterparts.

Further analysis suggested use of ACE/ARBs (29.6% [95% CI, 25.7% to 33.9%] vs 40.0% [95% CI, 36.1% to 44.0%]; P=.001) and lipid-lowering medications (25.3% [95% CI, 22.1% to 28.7%] vs 39.6% [95% CI, 36.1% to 43.2%]; P <.001) were lower among women than men. Investigators also pointed out women had significantly greater pulse rates and HbA1c levels than their male counterparts. Additionally, women were less likely to achieve goal for tight glycemic control less often than their male counterparts (11.2% [95% CI, 9.3% to 13.3%] vs 14.0% [95% CI, 12.0% to 16.3%]; P=.03).

“The findings of this cohort study suggest that compared with men with type 1 diabetes, women with type 1 diabetes may have a lower burden of cardiometabolic risk factors, receive less aggressive cardioprotective medications (despite current guidelines), and have no advantage associated with sex in CVD outcomes,” investigators wrote.

This study, “Cardiometabolic Risk Factors and Incident Cardiovascular Disease Events in Women vs Men with Type 1 Diabetes,” was published in JAMA Network Open.