Nathan D Wong1, Amber R Cordola Hsu1, Alan Rozanski2, Leslee J Shaw3, Seamus P Whelton4, Matthew J Budoff5, Khurram Nasir6, Michael D Miedema7, John Rumberger8, Michael J Blaha4, Daniel S Berman9. 1. Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA. 2. Division of Cardiology, Mount Sinai Morningside, New York, NY. 3. Department of Radiology, Cornell University, New York, NY. 4. Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, John Hopkins University, Baltimore, MD. 5. Lindquist Institute, Torrance, CA. 6. Division of Cardiology, Baylor College of Medicine, Houston, TX. 7. Cardiovascular Prevention, Minneapolis Heart Institute and Foundation, Minneapolis, MN. 8. Princeton Longevity Center, Princeton, NJ. 9. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA bermand@cshs.org.
Abstract
OBJECTIVE: While diabetes has been previously noted to be a stronger risk factor for cardiovascular disease (CVD) in women compared with men, whether this is still the case is not clear. Coronary artery calcium (CAC) predicts coronary heart disease (CHD) and CVD in people with diabetes; however, its sex-specific impact is less defined. We compared the relation of CAC in women versus men with diabetes for total, CVD, and CHD mortality. RESEARCH DESIGN AND METHODS: We studied adults with diabetes from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality end points. RESULTS: Among 4,503 adults with diabetes (32.5% women) aged 21-93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor-adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P = 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101-400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P = 0.01). CONCLUSIONS: CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.
OBJECTIVE: While diabetes has been previously noted to be a stronger risk factor for cardiovascular disease (CVD) in women compared with men, whether this is still the case is not clear. Coronary artery calcium (CAC) predicts coronary heart disease (CHD) and CVD in people with diabetes; however, its sex-specific impact is less defined. We compared the relation of CAC in women versus men with diabetes for total, CVD, and CHD mortality. RESEARCH DESIGN AND METHODS: We studied adults with diabetes from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality end points. RESULTS: Among 4,503 adults with diabetes (32.5% women) aged 21-93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor-adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P = 0.01) and CVDmortality (1.47 vs. 1.27) (interaction P = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVDmortality, HRs with CAC scores of 101-400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P = 0.01). CONCLUSIONS: CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.
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