Abstract
Evidence has shown that women with type 2 diabetes mellitus (T2DM) have a greater risk of cardiovascular complications compared with men, but this sex difference is not clearly understood. This study assessed the microvascular function and circulatory biomarkers in postmenopausal women (PMW) with T2DM compared with diabetic men and their non-diabetic counterparts. Sixty participants were divided into nondiabetic PMW, PMW with T2DM, non-diabetic men, and diabetic men. Microvascular function was assessed using non-invasive equipment (EndoPAT®) and reported as reactive hyperemia index (RHI). Anthropometric and cardiovascular parameters were also measured. Two-way ANOVA was performed using sex (women or men) and T2DM (non-diabetic and diabetic) as the two factors. RHI impairment (1.97±0.14) was detected in diabetic PMW compared with women without T2DM (2.5±0.13) accompanied by lower adiponectin levels (T2DM: 9.3±1.2 and CTL: 13.8±1.8 ug/mL, P<0.05). An increase in the Nε-carboxymethyllysine (CML), nitrate/nitrite, and C-reactive protein (CRP) levels were observed in diabetic PMW compared to the other groups. Although a poor glycemia control was seen in diabetic men, neither RHI nor circulatory biomarkers were affected by T2DM. Multiple linear regression stratified by sex and T2DM identified some variables with RHI only in PMW with T2DM: HbA1c (P=0.003), body mass index (P=0.029), CML (P=0.032), and CRP (P=0.006). Diabetic PMW were more susceptible to the deleterious effects of hyperglycemia than men, showing microvascular dysfunction with high levels of pro-inflammatory mediators (CML and CRP) and a lower adiponectin concentration.
Highlights
Cardiovascular complications are common events in patients with type 2 diabetes mellitus (T2DM) with high morbidity and mortality, with a 2- to 3-fold increased risk of stroke, myocardial infarction, and peripheral artery disease compared with nondiabetic individuals [1]
Another issue related to sex differences in the diabetic status is to identify which risk factor(s) is/are more likely to be associated with cardiovascular diseases (CVD) in women with T2DM compared with men
Higher waist circumference (WC), body mass index (BMI), and glomerular filtration rate (GFR) values were found in women with T2DM while total cholesterol, low-density lipoprotein (LDL)-C, and non-high-density lipoprotein (HDL)-C concentrations were lower compared with non-diabetic women (Po0.05)
Summary
Cardiovascular complications are common events in patients with type 2 diabetes mellitus (T2DM) with high morbidity and mortality, with a 2- to 3-fold increased risk of stroke, myocardial infarction, and peripheral artery disease compared with nondiabetic individuals [1]. It has been shown that women with T2DM are at greater risk of cardiovascular diseases (CVD) than men by 4–5-fold [2–4]. Studies that evaluate vascular function associated with diabetes biomarkers may clarify sex differences and help the health care system consider this issue and pay special attention to diabetic women in the prevention of cardiovascular complications. Another issue related to sex differences in the diabetic status is to identify which risk factor(s) is/are more likely to be associated with CVD in women with T2DM compared with men. Previous studies have shown that women are more sensitive to risk factors for CVD than men, such as body mass index (BMI), abdominal circumference, total
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