The effect of type 1 diabetes mellitus on the gender difference in coronary artery calcification

J Am Coll Cardiol. 2000 Dec;36(7):2160-7. doi: 10.1016/s0735-1097(00)00986-4.


Objectives: To examine whether the gender difference in coronary artery calcification, a measure of atherosclerotic plaque burden, is lost in type 1 diabetic patients, and whether abnormalities in established coronary heart disease risk factors explain this.

Background: Type 1 diabetes abolishes the gender difference in coronary heart disease mortality because it is associated with a greater elevation of coronary disease risk in women than men. The pathophysiological basis of this is not understood.

Methods: Coronary artery calcification and coronary risk factors were compared in 199 type 1 diabetic patients and 201 nondiabetic participants of similar age (30 to 55 years) and gender (50% female) distribution. Only one subject had a history of coronary disease. Calcification was measured with electron beam computed tomography.

Results: In nondiabetic participants there was a large gender difference in calcification prevalence (men 54%, women 21%, odds ratio 4.5, p < 0.001), half of which was explained by established risk factors (odds ratio after adjustment = 2.2). Diabetes was associated with a greatly increased prevalence of calcification in women (47%), but not men (52%), so that the gender difference in calcification was lost (p = 0.002 for the greater effect of diabetes on calcification in women than men). On adjustment for risk factors, diabetes remained associated with a threefold higher odds ratio of calcification in women than men (p = 0.02).

Conclusions: In type 1 diabetes coronary artery calcification is greatly increased in women and the gender difference in calcification is lost. Little of this is explained by known coronary risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Calcinosis / epidemiology
  • Calcinosis / physiopathology*
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / physiopathology*
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / pathology*
  • Diabetes Mellitus, Type 1 / pathology*
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / pathology*
  • Diabetic Angiopathies / physiopathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Risk Factors
  • Sex Factors
  • Ultrasonography