Sex differences in Type 2 diabetes affect cardiovascular disease risk

In the United States slightly more than nine percent of the population had diabetes in 2012, and the number of people with Type 2 diabetes is increasing at a rapid rate. Type 2 diabetes is associated with the body not producing enough insulin to control blood sugar levels. Overall, men and women have similar rates of Type 2 diabetes, which affects about 12.6 million women and 13 million men age 20 and older in the United States.

"Cardiovascular disease may be more deadly for women with Type 2 diabetes than it is for men," said Judith G. Regensteiner, Ph.D, chair of the statement writing group and professor of medicine and director of the Center for Women's Health Research at the University of Colorado School of Medicine in Denver.

"While we don't fully understand how the inherent hormonal differences between men and women affect risk, we do know that some risk factors for heart disease and stroke affect women differently than men and there are disparities in how these risk factors are treated."

The statement notes women with Type 2 diabetes:

• have heart attacks at earlier ages than men;
• are more likely to die after a first heart attack than men;
• are less likely to undergo procedures to open clogged arteries, such as angioplasty or coronary artery bypass grafting than men;
• are less likely to be on cholesterol lowering drugs such as statins, take aspirin or useblood pressure-lowering medications than men;
• are less likely to have their blood sugar or blood pressure under control than men;
• develop Type 2 diabetes based on sex-specific differences, such as gestational diabetes and polycystic ovary syndrome

The statement also notes that African-American and Hispanic women with Type 2 diabetes are disproportionately affected by coronary artery disease and stroke as compared to men with Type 2 diabetes.

Observational studies suggest women with Type 2 diabetes may benefit more than men in reducing their risk of cardiovascular disease through lifestyle changes such as improved diet and more physical activity, but that women may need to exercise more frequently and more intensely than men.

While the new scientific statement clarifies some diabetes-related sex differences in heart and blood vessel disease, more research is necessary, according to the authors. Areas for further research include why women react differently than men to some medications, and why the risk of death from heart and blood vessel disease is worse among minorities than among whites.

"To improve health equity in women and men with diabetes, we need to understand and improve both the biological reasons for the disparities and also control cardiovascular risk factors equally in both women and men," Regensteiner said. "This statement is a call for action to do the compelling research that is so important for all people with diabetes."