Elsevier

Gender Medicine

Volume 9, Issue 4, August 2012, Pages 251-258
Gender Medicine

Original research
Sex Differences in Cardiovascular Disease Risk in Adolescents With Type 1 Diabetes

https://doi.org/10.1016/j.genm.2012.05.003Get rights and content

Abstract

Background

Cardiovascular disease is seen at a younger age and at a higher prevalence in patients with type 1 diabetes than in the general population. It is well described that women with type 1 diabetes have a higher relative risk of cardiovascular disease than men with type 1 diabetes, unlike that seen in the general population. The pathophysiology behind this is unknown.

Objective

We performed a cross-sectional study to examine sex differences in cardiovascular disease risk factors in adolescents with type 1 diabetes between ages 13 and 20 years, compared with children of a similar age without type 1 diabetes.

Methods

All patients underwent a dual energy x-ray absorptiometry scan to measure body composition and a pulse wave test measure of arterial elasticity. Fasting serum lipid levels, apolipoprotein B, and apolipoprotein C-III levels were measured in each patient. Twenty-nine children with type 1 diabetes (10 girls, 19 boys) and 37 healthy children (18 girls, 19 boys) participated.

Results

Although no sex differences for body mass index (P = 0.91) and glycosylated hemoglobin (P = 0.69) were seen, girls with type 1 diabetes had a significantly higher percent trunk fat compared with boys (P = 0.004). No sex differences were found (P > 0.05) for percent trunk fat in adolescents without diabetes. There was no sex difference among any other cardiovascular risk factors in either children with or without diabetes.

Conclusions

Female adolescents with type 1 diabetes have more centrally distributed fat, which may contribute to their relatively higher cardiovascular disease risk. Attenuation of the central distribution of fat through exercise and dietary modifications may help ameliorate their subsequent cardiovascular disease burden.

Introduction

Cardiovascular mortality is increased in patients with diabetes.1 Patients with type 1 diabetes have a cumulative mortality of 35% from coronary artery disease compared with 4% to 8% in the general population.2 However, women with both type 1 and type 2 diabetes have a higher relative risk of cardiovascular disease (CVD) than men. In a diabetes cohort of almost 24,000 patients in the United Kingdom diagnosed with diabetes before age 30 years, female patients had much higher standardized mortality ratios compared with male patients.3 Data from Alleghany county in Pennsylvania show a similar trend, with a standardized mortality ratio in women more than triple that seen in men.4 The higher relative risk in female patients with type 1 diabetes compared with male patients with type 1 diabetes is seen across all ages, with the highest relative risk seen in younger populations.5 In contrast, this sex difference is not evident in individuals without diabetes. These data suggest that women with diabetes lose the protection enjoyed by premenopausal women without diabetes.

The reasons for increased susceptibility to coronary artery disease in women with diabetes are not clear. Different risk factors contribute to CVD in men and women. In women with type 1 diabetes, waist-to-hip ratio, physical activity, and depressive symptomatology predicted coronary artery disease, whereas renal disease was a better predictor in men.6, 7 A study using electron beam computer tomography showed that women with diabetes have a significantly higher risk of coronary calcification compared with women without diabetes.8 For men there was no significant difference in the coronary calcification score between those with and without diabetes. Also in men the strongest predictor of death due to CVD was a previous history of CVD irrespective of diabetes status. Women with diabetes had a higher cardiovascular mortality even without a history of previous CVD compared with women without diabetes who have had a previous cardiovascular incident.9 These and other data suggest that diabetes somehow increases the cardiovascular burden in a gender-specific manner. The exact pathophysiology is yet to be elucidated.

Our study was done to examine the sex differences in cardiovascular disease risk factors (ie, body composition, vascular elasticity, lipid profile, and levels of apolipoprotein B [apo B] and apoliporotein C-III [apo C-III]) in adolescents with type 1 diabetes between ages 13 and 20 years. The control population consisted of adolescents without diabetes across the same age range. We hypothesized that female adolescents with type 1 diabetes will have more risk factors for cardiovascular disease than male adolescents with type 1 diabetes, whereas girls without type 1 diabetes will be relatively protected, as evident by fewer risk factors compared with their male counterparts.

Section snippets

Patients

This was a cross-sectional study of adolescents with and without type 1 diabetes between ages 13 and 20 years. Children across all weight ranges were recruited. Patients with type 1 diabetes were primarily recruited from diabetes clinics at the University of Oklahoma Health Sciences Center, and healthy subjects were recruited through recruitment fliers and campuswide E-mail messages. A total of 77 children were enrolled, and 68 completed the study. Data from 2 participants were not included in

Results

Twenty-nine adolescents and young adults with type 1 diabetes and 37 children without type 1 diabetes were recruited. The demographic information is given in Table I. There was no significant difference (P > 0.05) in age, HbA1C, weight, or BMI between boys and girls with type 1 diabetes. Similarly there was no sex difference in these demographic variables in subjects without type 1 diabetes.

There was no significant difference in total lean and fat mass between boys and girls with and without

Discussion

Our study demonstrates a higher trunk fat percentage in girls with type 1 diabetes compared with boys, but this sex difference was not present in subjects without type 1 diabetes. A study done by Inberg et al14 using DXA measurements, showed higher BMI and fat mass in girls with type 1 diabetes compared with control subjects tracked over a period of 6 years. However this group did not find any difference in regional adiposity between girls with and without type 1 diabetes. That study did not

Conclusions

Female adolescents and young adults with type 1 diabetes have more centrally distributed fat than their male counterparts, which may contribute to their relatively higher cardiovascular disease risk. Attenuation of the central distribution of fat through exercise and dietary modifications may help ameliorate their subsequent cardiovascular disease burden.

Conflicts of Interest

This work was supported by an investigator-initiated grant from Novo-Nordisk (No. C7042301). The study sponsor did not have any role in the study design, data analysis, or any other aspect of the manuscript. The authors have indicated that they have no other conflicts of interest regarding the content of this article.

Acknowledgments

This work was supported by a General Clinical Research Center grant (No. M01-RR-14467) from the National Institutes of Health National Center for Research Resources. Dr. Krishnan was involved in study design, data collection, data interpretation, literature search, and writing. Dr. Fields helped with study design, data collection, and writing. Drs. Copeland and Blackett helped with study design and writing. Dr. Anderson helped with statistical analysis. Dr. Gardner provided mentorship in study

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