Disclosures: Dugani and Mora report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
January 21, 2021
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Diabetes, insulin resistance associated with premature CHD onset in women

Disclosures: Dugani and Mora report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Diabetes and insulin resistance appeared to be the strongest determinants for premature onset of CHD in women, according to study data published in JAMA Cardiology.

“In the U.S., CHD is the No. 1 cause of death among adults and is a major public health problem, in particular, for young women, as they have a higher risk of CHD death compared to men and older women,” Sagar B. Dugani, MD, PhD, consultant in the division of hospital internal medicine at Mayo Clinic, told Healio. “Despite this, we have very little information on risk factors for CHD in young women, which aects our ability to screen and prevent CHD.”

Measuring blood glucose
Source: Adobe Stock

Factors for CHD

The researchers analyzed 28,024 healthy women aged 45 years or older from the prospective Women’s Health Study to determine the relative risk of clinical risk factors and lipid, lipoprotein, inflammatory and metabolic biomarkers related to incident CHD. Researchers stratified participants by age (< 55 years, 55-64 years, 65 years-74 years and 75 years). Participants provided blood samples for biomarker measurements.

During a median follow-up period of 21.4 years, 5.5% of participants experienced incident CHD; incidence rates per 100 person-years ranged from 0.07 for CHD onset in participants younger than 55 years (95% CI, 0.06-0.09) to 0.62 for CHD onset in participants aged at least 75 years (95% CI, 0.57-0.68).

Of the investigated clinical factors, researchers reported diabetes had the highest adjusted HR among participants of all ages (< 55 years, aHR = 10.71; 95% CI, 5.57-20.6; 75 years, aHR = 3.47; 95% CI 2.47-4.87). Other factors prominent in those younger than 55 years included metabolic syndrome (aHR = 6.09; 95% CI, 3.6-10.29), hypertension (aHR = 4.58; 95% CI, 2.76-7.6), obesity (aHR = 4.33; 95% CI, 2.31-8.11) and smoking (aHR = 3.92; 95% CI, 2.32-6.63).

Further biomarker analysis revealed lipoprotein insulin resistance had the highest association with CHD onset in participants younger than 55 years (aHR = 6.4; 95% CI, 3.14-13.06). Other biomarkers associated with CHD onset in participants younger than 55 years included LDL (aHR = 1.38; 95% CI, 1.1-1.74), non-HDL (aHR = 1.67; 95% CI, 1.36-2.04), apolipoprotein B (aHR = 1.89; 95% CI, 1.52-2.35) and triglycerides (aHR = 2.14; 95% CI, 1.72-2.67). Additional inflammatory biomarkers carried a 1.2-fold to 1.8-fold association with CHD onset. All factors attenuated with age.

Prioritize lifestyle improvements

“Our study underscores that women, especially younger and middle-aged women, should prioritize improving their lifestyle, heart healthy habits and cardiac risk factors as much as possible as these have very important consequences for a woman’s future risk of heart attack for many years to come,” Samia Mora, MD, cardiologist at Brigham and Women’s Hospital, told Healio. “Future studies will be required to integrate these ndings in health screening and preventive eorts; this study provides an opportunity to improve health advocacy and public health messaging on preventive health.”

For more information:

Sagar B. Dugani, MD, PhD, can be reached at dugani.chandrasagar@mayo.edu.

Samia Mora, MD, can be reached at smora@bwh.harvard.edu.