Gender difference in baroreflex sensitivity to predict cardiac and cerebrovascular events in type 2 diabetic patients

Circ J. 2011;75(6):1418-23. doi: 10.1253/circj.cj-10-1122. Epub 2011 Apr 9.


Background: Cardiovascular autonomic neuropathy is a major complication in patients with diabetes mellitus (DM), and baroreflex sensitivity (BRS) reportedly can predict cardiovascular prognosis in type 2 DM patients. The hypothesis that cardiovascular events are associated with gender differences in BRS was tested in the present study.

Methods and results: From 1998, we have evaluated BRS by phenylephrine methods in 185 consecutive type 2 DM patients. The long-term prognostic value of BRS was compared between 91 female (5812 years) and 94 male patients (5811 years). There was no significant difference in age or severity and duration of DM between the 2 groups. When compared to male, the BRS value in female patients was significantly lower (9.266.0 vs. 5.975.0 ms/mmHg, P < 0.0001). During a mean of 62.7 months of follow-up, 16 female patients developed cardiovascular events (17.6%) including stroke, acute myocardial infarction, angina pectoris requiring percutaneous coronary intervention or coronary artery bypass grafting and congestive heart failure requiring admission, while only 4 male patients developed events (4.3%, P < 0.005). In females, the Kaplan-Meier curves revealed that those with depressed BRS (< 6 ms/mmHg) had a higher incidence of cardiovascular events than those with preserved BRS (P < 0.05), but this relationship was not observed in male patients.

Conclusions: Although the reason why females had a more depressed BRS remains unclear, our findings demonstrated that a depressed BRS value can accurately predict cardiovascular events, especially in female patients with type 2 DM.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Autonomic Nervous System / physiopathology*
  • Baroreflex*
  • Cerebrovascular Disorders / etiology*
  • Cerebrovascular Disorders / mortality
  • Cerebrovascular Disorders / physiopathology
  • Chi-Square Distribution
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / mortality
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetic Neuropathies / etiology*
  • Diabetic Neuropathies / mortality
  • Diabetic Neuropathies / physiopathology
  • Female
  • Heart Diseases / etiology*
  • Heart Diseases / mortality
  • Heart Diseases / physiopathology
  • Humans
  • Japan
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Time Factors