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Diabetes mellitus and cardiovascular disease in women
1Division of Endocrinology, Metabolism and Hypertension, Wayne State University School of Medicine, Detroit, Mich 48201, USA. sowers@oncgate.roc.wayne.edu
Insights
Menopause erases the protective effects of female hormones against coronary heart disease (CHD). Diabetes exacerbates this risk in women, increasing mortality from CHD.
Area of Science:
- Cardiovascular Health
- Endocrinology
- Women's Health
Background:
- Coronary heart disease (CHD) is a leading cause of death in US women.
- CHD prevalence increases in postmenopausal women, linked to reduced female sex hormones.
- Diabetes eliminates the typical sex difference in CHD prevalence.
Purpose of the Study:
- To investigate the role of female sex hormones in cardiovascular health.
- To examine the impact of diabetes on CHD risk and outcomes in women.
Main Methods:
- Observational epidemiological studies were analyzed.
- Data on blood pressure, menopause, CHD, and diabetes in women were reviewed.
Main Results:
- Estrogen and progesterone may protect against hypertension and CHD postmenopause.
- Diabetes negates the protective effects of female sex hormones against CHD.
- Women with CHD and diabetes face higher mortality rates than those without diabetes.
Conclusions:
- Diabetes appears to counteract the cardioprotective effects of female sex hormones.
- The interaction between diabetes and female hormones significantly increases CHD mortality in women.
Background:
Coronary heart disease (CHD) is the leading cause of morbidity and mortality in women in the United States. Although CHD is less common in premenopausal women than in men, this difference begins to disappear after the onset of menopause, presumably related to reduced levels of female sex hormones.
Results:
An association between both a postmenopausal increase in blood pressure and CHD that coincide with loss of ovarian function suggests that estrogen and/or progesterone may be protective against hypertension and CHD. Diabetes removes the normal sex difference in the prevalence of CHD. Increased mortality in women with CHD and diabetes compared with women without diabetes has been observed in epidemiological studies.
Conclusions:
Diabetes appears to obviate the protective effects of female sex hormones. Possible reasons for this catastrophic effect of diabetes in women are discussed.