Sex Differences in Cardiovascular Disease and Cardiovascular Risk Estimation in Patients With Type 1 Diabetes

J Clin Endocrinol Metab. 2023 Aug 18;108(9):e789-e798. doi: 10.1210/clinem/dgad127.

Abstract

Context: Patients with type 1 diabetes (T1D) have higher cardiovascular disease (CVD) risk than the general population.

Objective: This observational study aims to evaluate sex-related differences in CVD prevalence and CVD risk estimates in a large cohort of T1D adults.

Methods: We conducted a multicenter, cross-sectional study involving 2041 patients with T1D (mean age 46 years; 44.9% women). In patients without pre-existing CVD (primary prevention), we used the Steno type 1 risk engine to estimate the 10-year risk of developing CVD events.

Results: CVD prevalence (n = 116) was higher in men than in women aged ≥55 years (19.2 vs 12.8%, P = .036), but comparable between the 2 sexes in those aged <55 years (P = .91). In patients without pre-existing CVD (n = 1925), mean 10-year estimated CVD risk was 15.4 ± 0.4% without any significant sex difference. However, stratifying this patient group by age, the 10-year estimated CVD risk was significantly higher in men than in women until age 55 years (P < .001), but this risk equalized after this age. Carotid artery plaque burden was significantly associated with age ≥55 years and with a medium and high 10-year estimated CVD risk, without any significant sex difference. Diabetic retinopathy and sensory-motor neuropathy were also associated with higher 10-year CVD risk and female sex.

Conclusion: Both men and women with T1D are at high CVD risk. The 10-year estimated CVD risk was higher in men aged <55 years than in women of similar age, but these sex differences disappeared at age ≥55 years, suggesting that female sex was no longer protective.

Keywords: CVD; cardiovascular risk; gender; type 1 diabetes.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Adult
  • Cardiovascular Diseases* / complications
  • Cardiovascular Diseases* / etiology
  • Child
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1* / complications
  • Diabetes Mellitus, Type 1* / epidemiology
  • Female
  • Heart Disease Risk Factors
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Sex Characteristics