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Sex Differences in Coronary Microvascular Function in Individuals With Type 2 Diabetes

Andrea V Haas1, Bernard A Rosner2, Raymond Y Kwong3

  • 1Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA ahaas2@bwh.harvard.edu.

Diabetes
|November 10, 2018
PubMed

Insights

Women with type 2 diabetes show worse coronary microvascular dysfunction and diastolic function than men, even with good control. Higher aldosterone response in women may explain these cardiovascular differences.

Area of Science:

  • Cardiology
  • Endocrinology
  • Medical Research

Background:

  • Cardiovascular disease fatality rates are higher in women with diabetes compared to men.
  • Coronary microvascular dysfunction, indicated by impaired coronary flow reserve (CFR), is a key factor in adverse cardiovascular events.
  • Type 2 diabetes complicates cardiovascular risk assessment, particularly regarding sex-based disparities.

Purpose of the Study:

  • To investigate sex disparities in coronary microvascular dysfunction among individuals with well-controlled type 2 diabetes.
  • To compare coronary microvascular function and diastolic function between men and women with type 2 diabetes.
  • To explore the role of aldosterone in sex-specific differences in cardiovascular function.

Main Methods:

  • Post hoc analysis of 46 men and 27 women with type 2 diabetes and no obstructive coronary artery disease.
  • Measurement of rest and adenosine-stimulated myocardial blood flow (MBF) to calculate CFR.
  • Assessment of diastolic function and aldosterone levels following angiotensin-II infusion.

Main Results:

  • Women exhibited higher rest MBF, lower CFR, and poorer diastolic function compared to men.
  • Rest MBF was positively correlated with worse diastolic function in women.
  • Women showed a greater increase in aldosterone levels in response to angiotensin-II infusion than men.

Conclusions:

  • Women with type 2 diabetes and good cardiometabolic control demonstrate impaired myocardial perfusion and diastolic function relative to men.
  • Sex differences in cardiovascular outcomes may be linked to greater aldosterone responsivity in women.
  • Aldosterone may play a significant role in the pathophysiology of coronary microvascular dysfunction in diabetic women.

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