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Sex differences in micro- and macro-vascular complications of diabetes mellitus
1Division of Cardiovascular Sciences, Vascular Biology and Hypertension Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, U.S.A. christine.maric-bilkan@nih.gov.
Insights
Diabetes impacts men and women differently, with men facing higher microvascular risks and women experiencing greater macrovascular consequences. Understanding sex-specific factors is key for tailored diabetes vascular complication treatments.
Area of Science:
- Endocrinology and Metabolism
- Cardiovascular Science
- Sex Differences in Disease
Background:
- Vascular complications are a major cause of illness and death in type 1 (T1DM) and type 2 diabetes (T2DM).
- Sex influences the prevalence, progression, and pathophysiology of microvascular (e.g., nephropathy, retinopathy) and macrovascular (e.g., CHD, stroke) complications.
Purpose of the Study:
- To review the sex-specific differences in diabetic vascular complications.
- To explore the role of sex hormones and other factors in these disparities.
- To highlight areas for future research in personalized diabetes care.
Main Methods:
- Literature review and synthesis of existing research on sex differences in diabetic vascular disease.
- Discussion of the complex roles of sex hormones (estrogens, androgens) in cardiovascular health and diabetes.
- Analysis of sex-specific risk factors contributing to vascular complications.
Main Results:
- Men generally have a higher risk of microvascular complications.
- Women may face greater risks from macrovascular complications, a reversal of their pre-diabetes risk.
- Diabetes exacerbates vascular risks more significantly in women than men.
Conclusions:
- Sex hormones have complex, often counterintuitive, effects on cardiovascular function in diabetes.
- Understanding sex-specific mechanisms is crucial for developing personalized and sex-specific treatments for diabetic vascular disease.
- Further research is needed to resolve remaining questions and controversies regarding sex differences in diabetic pathophysiology.
Abstract:
Vascular complications are a leading cause of morbidity and mortality in both men and women with type 1 (T1DM) or type 2 (T2DM) diabetes mellitus, however the prevalence, progression and pathophysiology of both microvascular (nephropathy, neuropathy and retinopathy) and macrovascular [coronary heart disease (CHD), myocardial infarction, peripheral arterial disease (PAD) and stroke] disease are different in the two sexes. In general, men appear to be at a higher risk for diabetic microvascular complications, while the consequences of macrovascular complications may be greater in women. Interestingly, in the absence of diabetes, women have a far lower risk of either micro- or macro-vascular disease compared with men for much of their lifespan. Thus, the presence of diabetes confers greater risk for vascular complications in women compared with men and some of the potential reasons, including contribution of sex hormones and sex-specific risk factors are discussed in this review. There is a growing body of evidence that sex hormones play an important role in the regulation of cardiovascular function. While estrogens are generally considered to be cardioprotective and androgens detrimental to cardiovascular health, recent findings challenge these assumptions and demonstrate diversity and complexity of sex hormone action on target tissues, especially in the setting of diabetes. While some progress has been made toward understanding the underlying mechanisms of sex differences in the pathophysiology of diabetic vascular complications, many questions and controversies remain. Future research leading to understanding of these mechanisms may contribute to personalized- and sex-specific treatment for diabetic micro- and macro-vascular disease.