Coronary vascular dysfunction in premenopausal women with diabetes mellitus
Marcelo F Di Carli1, Luis Afonso, Roxana Campisi
1Department of Medicine, Wayne State University School of Medicine, Detroit, Mich, USA. mdicarli@partners.org
Insights
Premenopausal women with diabetes exhibit impaired coronary vascular function, similar to postmenopausal women. This suggests diabetes exacerbates cardiovascular risk by affecting blood flow regulation in coronary arteries.
Area of Science:
- Cardiovascular physiology
- Endocrinology
- Women's health
Background:
- Diabetes mellitus eliminates the sex difference in coronary artery disease (CAD) risk in premenopausal women.
- This suggests diabetes-associated cardiovascular risk may stem from mechanisms beyond typical risk factors, potentially involving impaired coronary vascular function.
- Investigating diabetes' impact on coronary vascular function in premenopausal women is crucial for understanding this elevated risk.
Purpose of the Study:
- To investigate the effect of diabetes mellitus on coronary vascular function in premenopausal women.
- To compare coronary vascular function in premenopausal women with and without diabetes, as well as with postmenopausal women.
Main Methods:
- Positron emission tomography (PET) with [13N]-ammonia was used to measure myocardial blood flow (MBF).
- MBF was assessed at rest, during hyperemia, and in response to cold pressor testing (CPT) in 13 premenopausal women with diabetes, 12 age-matched premenopausal controls, and 9 postmenopausal controls.
- Coronary vascular resistance (CVR) was calculated, and responses were adjusted for rate-pressure product and metabolic abnormalities.
Main Results:
- While all groups showed increased MBF during hyperemia, the percentage increase was significantly lower in women with diabetes compared to premenopausal controls (164% vs. 258%, P=.021).
- The response to CPT was also significantly blunted in women with diabetes compared to premenopausal controls (24% vs. 60%, P=.013).
- These impaired vasodilator and sympathetic responses in diabetic women were similar to those in postmenopausal controls and persisted after adjustments.
Conclusions:
- Premenopausal women with diabetes demonstrate reduced coronary vasodilator function.
- These women also exhibit an impaired response of coronary resistance vessels to sympathetic stimulation, mirroring findings in postmenopausal women.
- These vascular dysfunctions likely contribute to the increased cardiovascular risk observed in premenopausal women with diabetes.
Background:
Diabetes mellitus abolishes the sex differential in coronary artery disease morbidity and mortality in premenopausal women. This finding is independent of other diabetes-associated risk factors, suggesting that other mechanisms such as impaired coronary vascular function may contribute to the increased cardiovascular risk in women with diabetes. The objective of this study was to investigate the effect of diabetes on coronary vascular function in premenopausal women.
Methods:
We studied 13 premenopausal women with diabetes (aged 41 +/- 10 years) who were free of overt cardiovascular complications, and 21 control women (12 age-matched and 9 postmenopausal [aged 56 +/- 8 years]). We used [13N]-ammonia as the flow tracer and positron emission testing to measure myocardial blood flow (MBF) at rest, during maximal hyperemia, and in response to cold pressor testing.
Results:
Baseline MBF was lower in the postmenopausal controls, reflecting the differences in cardiac work and oxygen demand as assessed by the rate-pressure product. However, baseline MBFs were similar in the 3 groups after normalization for differences in the rate-pressure product. During hyperemia, MBF increased and coronary vascular resistance decreased significantly in the 3 groups. However, the increase (from baseline) in MBF in the women with diabetes (164% +/- 58%) was less than in the premenopausal controls (258% +/- 81%, P =.021), but not significantly different from the postmenopausal control women (204% +/- 104%, P =.51). Likewise, the increase in MBF in response to cold pressor testing in the women with diabetes (24% +/- 19%) was significantly lower than in the premenopausal controls (60% +/- 39%, P =.013), but similar to that in postmenopausal control women (27% +/- 15%, P =.97). These differences persisted after adjusting for age and diabetes-associated metabolic abnormalities.
Conclusions:
These results demonstrate reduced coronary vasodilator function and impaired response of resistance vessels to increased sympathetic stimulation in premenopausal women with diabetes, similar to those observed in healthy postmenopausal women in whom the sex differential in coronary artery disease morbidity and mortality is no longer present.
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