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Cardiovascular and Metabolic Risk

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium

  1. Nathan D. Wong1,
  2. Amber R. Cordola Hsu1,
  3. Alan Rozanski2,
  4. Leslee J. Shaw3,
  5. Seamus P. Whelton4,
  6. Matthew J. Budoff5,
  7. Khurram Nasir6,
  8. Michael D. Miedema7,
  9. John Rumberger8,
  10. Michael J. Blaha4 and
  11. Daniel S. Berman9⇑
  1. 1Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA
  2. 2Division of Cardiology, Mount Sinai Morningside, New York, NY
  3. 3Department of Radiology, Cornell University, New York, NY
  4. 4Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, John Hopkins University, Baltimore, MD
  5. 5Lindquist Institute, Torrance, CA
  6. 6Division of Cardiology, Baylor College of Medicine, Houston, TX
  7. 7Cardiovascular Prevention, Minneapolis Heart Institute and Foundation, Minneapolis, MN
  8. 8Princeton Longevity Center, Princeton, NJ
  9. 9Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA
  1. Corresponding author: Daniel S. Berman, bermand{at}cshs.org
  1. N.D.W. and A.R.C.H. contributed equally to this work.

Diabetes Care 2020 Oct; 43(10): 2597-2606. https://doi.org/10.2337/dc20-0166
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Abstract

OBJECTIVE While diabetes has been previously noted to be a stronger risk factor for cardiovascular disease (CVD) in women compared with men, whether this is still the case is not clear. Coronary artery calcium (CAC) predicts coronary heart disease (CHD) and CVD in people with diabetes; however, its sex-specific impact is less defined. We compared the relation of CAC in women versus men with diabetes for total, CVD, and CHD mortality.

RESEARCH DESIGN AND METHODS We studied adults with diabetes from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality end points.

RESULTS Among 4,503 adults with diabetes (32.5% women) aged 21–93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor–adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P = 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101–400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P = 0.01).

CONCLUSIONS CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.

Footnotes

  • This article contains supplementary material online at https://doi.org/10.2337/figshare.12691940.

  • Received January 23, 2020.
  • Accepted July 15, 2020.
  • © 2020 by the American Diabetes Association
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Diabetes Care: 43 (10)

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October 2020, 43(10)
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Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium
Nathan D. Wong, Amber R. Cordola Hsu, Alan Rozanski, Leslee J. Shaw, Seamus P. Whelton, Matthew J. Budoff, Khurram Nasir, Michael D. Miedema, John Rumberger, Michael J. Blaha, Daniel S. Berman
Diabetes Care Oct 2020, 43 (10) 2597-2606; DOI: 10.2337/dc20-0166

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Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium
Nathan D. Wong, Amber R. Cordola Hsu, Alan Rozanski, Leslee J. Shaw, Seamus P. Whelton, Matthew J. Budoff, Khurram Nasir, Michael D. Miedema, John Rumberger, Michael J. Blaha, Daniel S. Berman
Diabetes Care Oct 2020, 43 (10) 2597-2606; DOI: 10.2337/dc20-0166
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