Diabetes strongest threat issue for untimely CHD threat in ladies


medwireNews: Analysis of the Women’s Health Study shows that diabetes is more closely associated with the risk of premature coronary artery disease (CHD) than any other clinical risk factor or biomarker.

Diabetes was associated with a 10.71-fold increased risk of developing premature CAD (before age 55) during a median follow-up of 21.4 years after factors such as ethnicity and educational level were considered.

Diabetes was also associated with a 10.92-fold increased risk of developing CHD between the ages of 55 and 64, but the risk increase was mitigated in older participants, with diabetes being 4.49-fold and 3.47-fold Increased risk of CHD has been linked to women aged 65 to 74 years and 75 years or older, respectively.

This age-related risk reduction was observed for almost all risk factors, including BMI categories, smoking status, hypertension, and parental early onset myocardial infarction, as well as a number of lipid, metabolic, and inflammatory biomarkers.

However, this should not mean that risk factors are more important at younger or older age, writes Samia Mora (Brigham and Women’s Hospital, Boston, Massachusetts, USA), studying co-authors at JAMA Cardiology.

Instead, the results emphasize “the need for improved primary prevention in younger women,” it said.

The team’s analysis included 28,024 participants, of whom 1548 (5.5%) developed CAD. Of the clinical risk factors, obesity, high blood pressure, metabolic syndrome and current smoking were also significantly associated with premature CHD, with the risk increase between 3.92 and 6.09 times.

“The study results underscore the importance of diabetes and insulin resistance as major determinants of premature CHD, as well as other major changeable risk factors that can be addressed with lifestyle or preventive interventions,” the researchers say.

All of the inflammatory biomarkers examined were significantly associated with the risk of premature CHD, as were most of the lipid measurements.

However, Mora and the team note that the magnitudes of associations between lipids and CAD were less than those used for measuring lipoprotein insulin resistance (LPIR).

They explain that this measure is based on lipoprotein sub-fractions as a correlate of insulin resistance according to HOMA-IR and that it was previously associated with the incidence of diabetes independently of statin therapy.

LPIR was more strongly associated with premature CHD than any other lipid, inflammatory, or metabolic measure, including glycated hemoglobin, and, moreover, the association was only slightly attenuated after considering pre-existing diabetes.

“The LPIR score may link insulin resistance and the accompanying atherogenic dyslipoproteinemia to future risk of diabetes and premature CHD,” the researchers suggest, adding that further investigation of this risk factor is needed.

medwireNews is an independent medical news service from Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

JAMA Cardiol 2021; doi: 10.1001 / jamacardio.2020.7073