Effect of type 1 diabetes on the gender difference in coronary artery calcification: a role for insulin resistance? The Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study

Diabetes. 2003 Nov;52(11):2833-9. doi: 10.2337/diabetes.52.11.2833.


The objective of this is study was to examine whether estimated insulin resistance and insulin resistance-related factors are associated with coronary artery calcification (CAC) in 1,420 asymptomatic participants in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. A total of 656 patients with type 1 diabetes and 764 control subjects aged 20-55 years were examined. CAC was assessed by electron-beam computed tomography. Insulin resistance was computed with linear regression based on an equation previously validated in clamp studies on type 1 diabetic adults. Insulin resistance was associated with CAC (OR 1.6 in type 1 diabetes and 1.4 in control subjects, P < 0.001), independent of coronary artery disease risk factors. There was a male excess of CAC in control subjects (OR 2.7, adjusted for age, smoking, and LDL and HDL cholesterol levels) and in type 1 diabetic patients (OR 2.2, adjusted for the same factors and diabetes duration). After adjusting for insulin resistance, the CAC male excess in diabetic patients decreased from OR 2.2 (P < 0.001) to 1.8 (P = 0.04). After adjustment for waist-to-hip ratio, waist circumference, or visceral fat, the gender difference in CAC was not significant in diabetic subjects. In conclusion, gender differences in insulin resistance-associated fat distribution may explain why type 1 diabetes increases coronary calcification in women relatively more than in men.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Body Mass Index
  • Calcinosis / diagnostic imaging
  • Calcinosis / epidemiology
  • Calcinosis / physiopathology*
  • Coronary Disease / diagnostic imaging
  • Coronary Disease / epidemiology
  • Coronary Disease / physiopathology*
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Diabetic Angiopathies / physiopathology*
  • Female
  • Humans
  • Hypertension / epidemiology
  • Insulin Resistance
  • Male
  • Middle Aged
  • Prevalence
  • Reference Values
  • Sex Characteristics
  • Tomography, X-Ray Computed