Women with diabetes between the ages of 45 and 65 have a 10-fold increased risk of coronary artery disease (CHD) compared to women of similar ages without diabetes, according to a new analysis by the US-based Women’s Health Study.
Identifying individuals at risk for premature CHD that occurs in women before age 65 or in men before age 55 is critical to reducing the burden of premature morbidity and mortality, explains Dr. med. Sagar Dugani from Mayo Clinic, Rochester, USA. Minnesota and colleagues in their article published online Jan. 20 in JAMA Cardiology.
Although CHD mortality among adults under 55 years of age in the United States decreased 5.5% in men and 4.6% in women from 1979 to 1989, mortality in women remained virtually unchanged for the next 20 years.
“Younger women are an important demographic, and we don’t understand why their risk of death is higher,” Dugani told Medscape Medical News. “Why don’t they show the same improvement as men? Are we missing risk factors? We need these answers to intervene.”
In addition to diabetes, a new measurement that reflects insulin resistance, known as the lipoprotein insulin resistance score (LPIR), has the highest predictive risk of premature CHD out of 50 biomarkers that Dugani and colleagues studied.
“These data show the importance of diabetes and insulin resistance in younger women, especially women under 55, for whom very little information is available,” Dugani said.
We rated [adjusted hazard ratios] for many risk factors, but the LPIR score was noticeable in women under 55 years of age [and]… was significantly higher compared to older groups, “he added.
Heart disease assessed in four age groups
Dugani and his research team at Brigham and Women’s Hospital in Boston, Massachusetts examined the contribution of several clinical, lipid, metabolic, and inflammatory risk factors to the risk of CHD in women over 45 years of age.
Data on just over 28,000 female health professionals with no known cardiovascular disease (CVD) with a mean follow-up of 21.4 years were drawn from the women’s health study.
Risk factors and 50 biomarkers, including lipids, triglycerides, lipoproteins, inflammation and metabolic markers, measured at baseline, were divided into four age groups (<55, 55 - <65, 65 - <75 and ≥) for their association with the occurrence of KHK examines 75 years).
In the under 55-year-olds, the presence of diabetes was associated with a 10-fold increased risk of CHD (adjusted hazard ratio) [HR]10.71); This association was weakened with increasing age of the women, with an aHR of 3.47 in subjects 75 and over.
Metabolic syndrome (aHR, 6.09), hypertension (aHR, 4.58), obesity (aHR, 4.33) and smoking (aHR, 3.92) were other important risk factors for the occurrence of CHD in women under 55 years of age ).
However, Dugani stressed that the lower exposure rates for some risk factors in older age groups “do not suggest that health care becomes less important with age … Risk factor management is important at any age.”
Some risk factors were important for all age groups, such as: B. physical inactivity, in which the risk rates associated with CHD did not change significantly in old women (aHR, 1.53, 1.59, 1.43, 1.21 for <55, 55 - <65, 65 - < 75, ≥ 75 years).
Overall, the study reiterates messages about prevention, said Dugani. “It depends on the lifestyle of the four S – sugar, salt, sedentary lifestyle and smoking” and how best to avoid them.
LPIR offers “all-round” measures, but is not yet available in the clinic
The researchers examined about 50 biomarkers and found that the novel LPIR score has the strongest association with CHD risk in younger women.
LPIR comprises a weighted combination of six lipoprotein measures related to the concentration and size of high density lipoprotein (HDL), low density lipoprotein (LDL), and triglyceride-rich lipoprotein particles.
Although classified as a metabolic marker and used in research, it is not yet routinely available in clinics.
“LPIR takes into account other factors (particle size and number) that do not make up LDL cholesterol or HDL cholesterol alone, and therefore provides a better overall measure of the insulin resistance lipoprotein profile,” explained Dugani.
These latter traditional biomarkers had much weaker associations with the occurrence of CHD than LPIR in younger women (under 55 years of age).
LPIR was associated with a 600% increased CHD risk in women under 55 years of age (aHR, 6.4) compared to LDL cholesterol, which was associated with a 40% increase in CHD risk in this subgroup.
“When comparing the risk factors, we were surprised that LPIR was noticed to this extent,” said Dugani.
Mora has reported that she has received institutional research grants from Atherotech Diagnostics for research outside of current work who acts as a consultant to Quest Diagnostics and holds a patent related to GlycA use and colon cancer risk. The other authors did not report any relevant financial relationships.
JAMA Cardiol. Published online January 20, 2021. Full text
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