Type 2 diabetes mellitus is considered a major risk factor in cardiovascular disease (CVD) in both men and women, but CVD pathogenesis biochemistry can differ between the sexes.
Both sexes are affected by insulin resistance, which generally precedes the diabetes, and accompanying metabolic syndrome factors dyslipidemia and hypertension (1). The insulin resistance leads to elevated insulin levels, which stimulates sodium reabsorption. The sodium levels can induce prolonged hypertension. The hypertension leads to hardening of the arteries and eventual atherosclerosis. The chronic hyperglycemia leads to glycation of myocardial proteins and microvascular disease (1;2). Gradual nerve damage from abnormal signaling leads to autonomic neuropathy (2).
Although women have overall lower risk of heart disease than men before age 60 due in part because of estrogen, diabetes abolishes difference in CVD risk. In fact, diabetes in women is reported to increase risk of CVD three- to seven-fold whereas in men it increases risk two- to three-fold (3).
Diabetes is thought to affect women uniquely because of hormonal status. Diabetes appears to cancel benefits of estrogen, which “may be lost or hidden by diabetes” (3). With reduced estrogen, other CVD risk factors come into play in a pre-menopausal women just as it would for post-menopausal women (3).
1. Grundy SM. Cardiovascular and metabolic risk factors: how can we improve outcomes in the high-risk patient? Am J Med 2007;120:S3-S8.
2. Grundy SM, Benjamin IJ, Burke GL et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999;100:1134-46.
3. Bolego C, Cignarella A, Zancan V, Pinna C, Zanardo R, Puglisi L. Diabetes abolishes the vascular protective effects of estrogen in female rats. Life Sci 1999;64:741-9.