With cases of obesity and type 2 diabetes at record numbers in the United States, new research reveals that women with “pre-diabetes” may experience blood vessel dysfunction, clot formation and high blood pressure more often than men, possibly making them more vulnerable to heart disease in the future.
“Pre-diabetes is a condition, not a disease, when fasting blood sugar is 100-125 mg/dl,” explains Richard P. Donahue, Ph.D., M.P.H., professor at the School of Public Health and Health Professions at the State University of New York at Buffalo and lead author of the study. In other words, in pre-diabetes, blood glucose levels are higher than normal, but not high enough to reach the diagnostic criteria for diabetes. Studies show that a considerable number of people with pre-diabetes develop type 2 diabetes later in life.
It has long been established that differences between women and men exist when it comes to diabetes and heart disease risk. Some studies have shown that diabetic women have a greater risk of coronary heart disease than diabetic men. Other studies have shown that the risk of a heart attack is higher in female diabetics than in male diabetics. This new study suggests that even before diabetes is diagnosed, there may be significant differences that contribute to the risk of heart disease.
“The reasons why women with type 2 diabetes are at higher risk (for heart disease) than male diabetics are not well known,” Donahue said. “Some studies suggest that women may have more coronary microvascular disease, as opposed to disease in the larger coronary arteries, but this is only a hypothesis.”
From this study, it is feasible to speculate that pre-diabetic women may be more prone to blood vessel dysfunction and clotting problems than pre-diabetic men, but more studies are needed to further examine the role sex—the biological status of being a woman or a man—plays in pre-diabetes and the risk of heart disease.
What is known for certain is that lifestyle changes in pre-diabetics, regardless of sex, can delay or prevent the onset of type 2 diabetes. Researchers have proven that healthy dietary choices and moderate physical activity can ward off the development of type 2 diabetes and further lower the risk of heart disease and stroke.
Diagnosing pre-diabetes in patients is very important because treating it may not only prevent the development of diabetes, it can also prevent the many, unwanted complications.
“Women should know their glucose value and have it measure annually from age 45 onwards,” Donahue said. “If it continues on an upward trend, the primary care docs may consider more intensive therapy for risk factors for heart disease including, hypertension and LDL cholesterol.”
Currently, the American Diabetes Association recommends that all adults aged 45 years and older be considered for diabetes screening by their health care provider every three years. However, the following people are at higher risk and should also consider pre-diabetes screening:
- People with a family history of type 2 diabetes;
- Overweight or obese people (Body Mass Index greater than 25);
- Women with a history of gestational diabetes;
- Women with polycystic ovary syndrome;
- People with a sedentary lifestyle; and
- High risk minority groups including: African Americans, Native Americans and Latinos.
Pre-diabetes can develop at any age and many American children and adolescents now have the condition. You also do not have to be significantly overweight to develop it, so individuals who do not eat a healthy diet or do not exercise regularly should be aware of the condition and talk to their health care providers.
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Sources
Almdal T., et al., The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med, 2004. 164(13): p. 1422-6.
Donahue R., et al. Sex Differences in Endothelial Function Markers Before Conversion to Pre-Diabetes: Does the Clock Start Ticking Earlier Among Women? Diabetes Care 30:354-359, 2007.
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Written by: Jennifer Wider, M.D.
Society for Women’s Health Research
Visit http://www.womenshealthresearch.org/site/PageServer?pagename=press_newsservice to find more articles on sex differences in women's health.
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Comments: 2
The above quote, by Dr. Richard P. Donahue, raises an interesting point (which many women don't know). As I recall, the findings of the National Heart, Lung, and Blood Institute's (NHLBI) Women's Ischemia Syndrome Evaluation (WISE) study, published in the February 6, 2006 issue of the Journal of the American College of Cardiology, showed that many women (their estimate was 3 million U.S. women) develop coronary microvascular syndrome, and go undiagnosed. (NHLBI is part of The National Institutes of Health.)
In this syndrome, plaque accumulates in tiny arteries of the heart, causing narrowing, reduced oxygen flow to the heart, and pain similar to what people with blocked arteries experience. A key difference between microvascular syndrome and blocked arteries is that, in the former, plaque does not show up when physicians use standard tests to diagnose heart disease. If the diagnosis is missed, women don't get treated for angina (brief attacks of chest pain caused by insufficient oxygen to the heart muscles) and high cholesterol. This leaves them at a higher risk of having a heart attack.
Such problems aren't better understood, or diagnosed more often, because the basis for standard methods of diagnosis and treatment are the result of research conducted almost exclusively on men. Men were used as the test subjects because males develop heart disease at an earlier age than women. Due to the lack of research on women, for many years, physicians believed that women didn't develop heart disease very often. In fact, women do develop heart disease, but roughly 10 to 15 years later than men, primarily due to the heart-protective effect of female hormones. In recent years, it has come to light that heart disease is the leading cause of death in women.
Additional research is needed to determine exactly why more women with type 2 diabetes are at higher risk for heart disease than their male counterparts, and more specifically, what may cause an increased risk of heart disease at the pre-diabetic stage.