Women with Type 2 diabetes are twice as likely to have coronary heart disease compared to men, and may need more frequent and intense physical activity to reduce the risk of heart attack or stroke, according to a scientific statement released this week by the American Heart Association and co-authored by Judith G. Regensteiner, PhD, of the University of Colorado School of Medicine.
“Cardiovascular disease may be even more deadly for women with Type 2 diabetes than it is for men,” said Professor Regensteiner, chair of the statement writing group and director of the Center for Women’s Health Research at the CU School of Medicine.
The scientific statement was published in the American Heart Association’s journal Circulation.
Dr. Judith G. Regensteiner, director of the Center for Women's Health Research at the CU School of Medicine.
The American Heart Assn. (AHA) and the American Stroke Assn. (ASA) publish scientific statements on a variety of topics, supported by studies published in recognized and rigorously reviewed journals. Statements generally include a review of available data on a specific subject, an evaluation of its relationship to overall cardiovascular disease science and often an AHA/ASA position on the basis of that evaluation.
Type 2 diabetes is associated with the body not producing enough insulin to control blood sugar levels. Overall, men and women have similar rates of Type 2 diabetes, which affects about 12.6 million women and 13 million men age 20 and older in the U. S.
“While we don’t fully understand how the inherent hormonal differences between men and women affect risk, we do know that some risk factors for heart disease and stroke affect women differently than men and there are disparities in how these risk factors are treated,” Regensteiner said.
The scientific statement notes that women with Type 2 diabetes:
- have heart attacks at earlier ages than men;
- are more likely to die after a first heart attack than men;
- are less likely to undergo procedures to open clogged arteries, such as angioplasty or coronary artery bypass grafting than men;
- are less likely to be on cholesterol lowering drugs such as statins, take aspirin or use blood pressure-lowering medications than men;
- are less likely to have their blood sugar or blood pressure under control than men;
- develop Type 2 diabetes based on sex-specific differences, such as gestational diabetes and polycystic ovary syndrome
It also points out that African-American and Hispanic women with Type 2 diabetes are disproportionately affected by coronary artery disease and stroke compared to men with the disease.
Observational studies suggest women with Type 2 diabetes may benefit more than men in reducing their risk of cardiovascular disease through lifestyle changes such as improved diet and more physical activity, but they may need to exercise more frequently and more intensely than men.
While the new scientific statement clarifies some diabetes-related sex differences in heart and blood vessel disease, more research is necessary, according to the authors. Scientists want to know why women react differently than men to some medications, and why the risk of death from heart and blood vessel disease is worse among minorities than among whites.
“To improve health equity in women and men with diabetes, we need to understand and improve both the biological reasons for the disparities and also control cardiovascular risk factors equally in both women and men,” Regensteiner said. “This statement is a call for action to do the compelling research that is so important for all people with diabetes.”
The co-authors are Sherita Hill Golden, M.D., Co-Chair; Amy G. Huebschmann, M.D.; Elizabeth Barrett-Connor, M.D.; Alice Y. Chang, M.D., M.Sc.; Deborah Chyun, Ph.D., R.N.; Caroline S. Fox, M.D.; Catherine Kim, M.D., M.P.H.; Nehal Mehta, M.D., M.S.C.E.; Jane Reckelhoff, Ph.D.; Jane E.B. Reusch, M.D.; Kathryn M. Rexrode, M.D., M.P.H.; Anne E. Sumner, M.D.; Francine K. Welty, M.D.; Nanette K. Wenger, M.D. and Blair Anton, M.L.I.S., M.S.
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