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.
“Few studies have followed women with type 1 diabetes as they transition through menopause,” 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 Type 1 Diabetes Study at the University of Colorado Anschutz Medical Campus in Aurora, Colorado, and colleagues wrote. “It is important to understand the effects of this transition on CVD risk because of the increasing incidence of type 1 diabetes and lower rates of diabetes-related mortality, which have the combined effect of increasing the number of older women with type 1 diabetes.”
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.
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.”
“It has already been established that premenopausal women with type 1 diabetes lose the cardiovascular protection that women without diabetes have, and the CACTI study provides evidence that menopause increases CVD risk more in women with type 1 diabetes than in women without diabetes,” the researchers wrote. “It is imperative to examine how diabetes and sex-specific risk factors may interact to affect cardiovascular risk in this growing population, and how treatments could modify this risk.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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