Abstract 14003: The Role of Sex Hormones in Accelerated Vascular Disease Among Premenopausal Women With Type 1 Diabetes
Women who have type 1 diabetes (T1D) suffer prematurely from coronary artery disease (CAD), resulting in increased mortality and approximately 15 years shorter lifespan than women without diabetes. This increased CAD risk is observed even during premenopausal years, when women are normally protected by estrogen. The objective of this study was to evaluate the increased risk of CAD in women with T1D, and examine whether levels of sex hormones, including testosterone and estrogen, explain part of this increased risk.
This analysis included 41 premenopausal women enrolled in the Women, Insulin and Sex Hormones (WISH) study (10 with T1D, age 32±8 years, diabetes duration 15.3±5.8 years and 31 non-diabetic controls, age 31±6 years). All participants had non-invasive measurements of vascular function using radial artery tonometry ( Sphygmocor) to measure carotid to femoral pulse wave velocity (PWV) on day 2-5 of their menstrual cycle. The PWV was completed three times and averaged for each study participant.
Women with T1D had higher femoral PWV than women without diabetes (7.3±1.2 vs. 6.4±0.9, p=0.02), but did not differ in terms of age, systolic or diastolic blood pressure, waist circumference, body mass index (BMI), total or HDL-cholesterol, or triglycerides. Levels of estradiol did not differ by diabetes status, but women with T1D had significantly higher total testosterone (44±12ng/dl vs. 31±8ng/dl, p=0.001) and sex hormone binding globulin (77±26 vs. 58±18, p=0.02). In linear regression analysis, femoral PWV remained higher in T1D when adjusted for age (p=0.03) and when further adjusted for estradiol (7.3±0.3 vs. 6.5 ± 0.2, p=0.03) and sex hormone binding globulin (7.6±0.3 vs. 6.5 ± 0.2, p=0.007), but adjustment for total testosterone attenuated the association of femoral PWV and T1D (7.1±0.4 vs. 6.6 ± 0.2, p=0.24).
Premenopausal women with T1D show signs of earlier arterial stiffening than women without diabetes, despite similar CAD risk factors. Higher levels of total testosterone are present in premenopausal women with T1D than in similar women without diabetes, and may explain some of the increased risk for CAD.
- © 2011 by American Heart Association, Inc.