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 - Funding Information:
Acknowledgments. The authors thank the participants of the Coronary Calcium Consortium. Funding. M.J.Bl. was supported by research funding from the National Institutes of Health and the American Heart Association. Duality of Interest. N.D.W. discloses research funding not related to the current manuscript from Amarin, Amgen, Boehringer Ingelheim, Novo Nordisk, and Novartis and serves on the speakers bureau for Amarin and Sanofi. M.J.Bu. discloses research grant support not related to the current manuscript from General Electric. M.J.Bl. discloses research funding from Aetna and Amgen and honoraria from Amgen, Sanofi, Regeneron, Novartis, Novo Nordisk, Bayer, Akcea, 89Bio, Zogenix, Tricida, and Gilead. No other potential conflicts of interest relevant to this article were reported. Author Contributions. N.D.W., A.R.C.H., and D.S.B. wrote the manuscript and provided critical revision and feedback. A.R.C.H. also conducted the analysis. A.R., L.J.S., S.P.W., M.J.Bu., K.N., M.D.M., J.R., and M.J.Bl. provided critical review and editorial suggestions. D.S.B. takes full responsibility for the work as a whole, including the study design, access to the data, and the decision to submit and publish the manuscript. D.S.B. is the guarantor of the study and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented in abstract form at the American Heart Association Scientific Sessions, Anaheim, CA, 11–15 November 2017.
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
VL - 43
SP - 2597
EP - 2606
JO - Diabetes Care
JF - Diabetes Care
SN - 1935-5548
IS - 10
ER -