October 03, 2019
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Menopause additionally increases atherosclerotic CVD risk for women with type 1 diabetes

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Women with type 1 diabetes have more coronary artery calcium compared with women without diabetes, and this difference only widens during menopause, potentially increasing cardiovascular risk, according to findings published in Diabetes Care.

“More people are being diagnosed with type 1 diabetes each year, and while people with type 1 diabetes are living longer than they used to, women with type 1 diabetes have a shorter life expectancy by about 13 years than women without diabetes,” Amena Keshawarz, MPH, a PhD candidate in the department of epidemiology, a predoctoral fellow in the division of geriatrics and a graduate research assistant for the Oral Microbiome in the Type 1 Diabetes Study at the University of Colorado Anschutz Medical Campus in Aurora, Colorado, told Endocrine Today. “If we can identify sex-specific and overall mechanisms for the increased cardiovascular risk, we can use that information to prevent complications and improve outcomes in this population as they live to older ages.”

Keshawarz and colleagues analyzed data from 311 premenopausal women with type 1 diabetes (mean age, 34 years) and 325 premenopausal women without the condition (mean age, 36 years) who participated in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. Participants were followed for 18 years. The researchers assessed coronary artery calcium, blood pressure, waist circumference, HDL cholesterol, LDL cholesterol, triglycerides and estimated glomerular filtration rate and calculated atherosclerotic CVD risk and BMI at baseline, 3 years, 6 years and 14 years.

Among the participants with type 1 diabetes, 24% were postmenopausal after 18 years while 30% of participants without diabetes were postmenopausal. For both groups, menopause began, on average, at age 50 years.

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Women with type 1 diabetes have more coronary artery calcium compared with women without diabetes, and this difference only widens during menopause, potentially increasing cardiovascular risk.

The researchers observed a statistically significant interaction between type 1 diabetes and menopause with coronary artery calcium. More specifically, they observed a mean coronary artery calcium volume of 2.91 mm3 among women with diabetes who were premenopausal after 18 years and a mean coronary artery calcium volume of 5.14 mm3 among women with diabetes who were postmenopausal after 18 years; mean volume was 1.78 mm3 for both premenopausal and postmenopausal women without diabetes (P < .0001).

Among women with diabetes, those who were postmenopausal after 18 years had an atherosclerotic CVD risk score of 2.7% and those who were premenopausal had an atherosclerotic CVD risk score of 1.5% compared with respective scores of 1.7% and 1.3% among women without diabetes who were postmenopausal and who were premenopausal (P = .0001). In addition, for systolic BP and diastolic BP, the researchers wrote that there was “a significant interaction between diabetes status and menopause status.”

“Our study showed that not only is cardiovascular risk higher in premenopausal women with type 1 diabetes than without diabetes, but this risk increases to a greater extent with menopause in women with type 1 diabetes,” Keshawarz said. “There’s a significant interaction between menopause and diabetes where menopause has a greater effect on coronary calcium in women with type 1 diabetes than in women without diabetes, but we don’t yet know what is explaining this dramatic difference between women with and without type 1 diabetes.” by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.