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(Circulation. 2000;101:2040.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Type II Diabetes Abrogates Sex Differences in Endothelial Function in Premenopausal Women

Helmut O. Steinberg, MD; Giancarlo Paradisi, MD; Jessica Cronin, RN; Kristin Crowde, RN; Annette Hempfling, RN; Ginger Hook, RN; Alain D. Baron, MD

From the Department of Medicine, Indiana University School of Medicine (H.O.S., G.P., J.C., K.C., A.H., G.H., A.D.B.), and the Richard L. Roudebush Veterans Affairs Medical Center (G.H., A.D.B.), Indianapolis, Ind.

Correspondence to Alain D. Baron, MD, Indiana University School of Medicine, 541 N Clinical Dr, CL 459, Indianapolis, IN 46202-5111. E-mail abaron{at}iupui.edu

Background—Obesity is a more potent cardiovascular risk factor (CVRF) in men than in women. Because traditional CVRFs cannot fully account for this sex difference, we tested the hypothesis that compared with men, women exhibit more robust endothelial function independent of obesity and that this sex difference is abrogated by diabetes.

Methods and Results—We studied leg blood flow (LBF) responses to graded intrafemoral artery infusions of the endothelium-dependent vasodilator methacholine chloride (Mch) and the endothelium-independent vasodilator sodium nitroprusside (SNP) in groups of lean, obese (OB), and type II diabetic (DM) premenopausal women and age- and body mass index–matched men. LBF response to intrafemoral administration of L-NMMA, an inhibitor of nitric oxide synthase, was also assessed in normal men and women. Maximum LBF increments in response to Mch were 347±57% versus 231±22% in lean women versus men (P<0.05) and 203±25% versus 111±17% in OB women versus men (P<0.01), respectively. In DM, maximum LBF increments in response to Mch were 104±24% and 138±33% in women and men, respectively, (P=NS). LBF decrements in response to L-NMMA were 34.9±4.1% and 17.1±4.2% in women and men, respectively (P<0.01). The response to SNP was not different between sexes and groups.

Conclusions—Premenopausal nondiabetic women exhibit more robust endothelium-dependent vasodilation owing to higher rates of nitric oxide release than men. Given the protective vascular action of nitric oxide, this difference may partially explain the lower incidence of macrovascular disease in women. In premenopausal women, DM causes impairment of endothelial function beyond that observed with obesity alone and leads to endothelial dysfunction similar to that observed in DM men. These findings may help explain the similar rates of coronary artery disease and mortality in diabetic men and women.

Key Words: endothelium • obesity • diabetes mellitus • sex

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