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Sex differences in cardiovascular disease risk in type 1 diabetes: The vascular bed paradox in women

Abigayle B Simon1, Dhruti Trivedi1, Marsha Blackburn1

  • 1Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA.

Diabetes & Vascular Disease Research
|May 30, 2026
PubMed

Insights

Women with type 1 diabetes (T1D) show better blood vessel function but increased aortic stiffness compared to men with T1D. This highlights the complex vascular health differences in T1D, requiring multiple assessments for cardiovascular disease risk.

Area of Science:

  • Cardiology
  • Endocrinology
  • Vascular Biology

Background:

  • Cardiovascular disease (CVD) is the primary cause of mortality in type 1 diabetes (T1D).
  • Women with T1D face a higher CVD risk than men with T1D.
  • Understanding sex-based differences in vascular health is crucial for T1D management.

Purpose of the Study:

  • To investigate sex-specific differences in vascular health among individuals with T1D.
  • To compare endothelial-dependent and -independent vasodilation between men and women with T1D.
  • To assess microvascular function, arterial stiffness, and skeletal muscle oxidative capacity in relation to sex.

Main Methods:

  • Flow-mediated dilation (FMD) for conduit artery endothelial function.
  • Nitroglycerin (NTG) testing for endothelial-independent vasodilation.
  • Cutaneous post-occlusive reactive hyperemia (PORH), local thermal heating (LTH), iontophoresis of acetylcholine (ACH), pulse wave velocity (PWV), pulse wave analysis (AIx75), and near-infrared spectroscopy for SMOC.

Main Results:

  • No significant differences in Hemoglobin A1c or microvascular function (PORH, LTH, ACH) between sexes.
  • Women with T1D demonstrated higher FMD (endothelial function) and AIx75 (aortic stiffness) compared to men with T1D.
  • Arterial stiffness (PWV) and skeletal muscle oxidative capacity (SMOC) were similar between groups.

Conclusions:

  • Women with T1D exhibit enhanced conduit vessel endothelial function but increased aortic stiffness versus men with T1D.
  • This paradox underscores the complexity of vascular health in T1D, necessitating comprehensive assessment.
  • Evaluating multiple vascular indices is vital for accurate CVD risk stratification in both sexes with T1D.

Keywords:
cardiovascular diseasesex differencestype 1 diabetesvascular function

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