Background: Studies indicate lower, comparable, and higher cardiovascular risks in women vs men in normal glucose regulation (NGR), prediabetes, and diabetes, respectively. However, this sex difference is uncertain and aging might play a part. We aimed to estimate sex differences in arterial stiffness in NGR, prediabetes, or diabetes and the potential modifications by age.
Methods: We used baseline data of 9618 participants aged ≥40 years in a large community-based cohort study in Shanghai. Glycemic status was determined by history of diabetes, fasting and 2-h post-load glucose levels, and hemoglobin A1c levels. Arterial stiffness was examined by brachial-ankle pulse wave velocity (ba-PWV). Multivariable linear regression analysis was conducted to examine the associations between sex and ba-PWV levels in glycemic and age categories.
Results: Before adjustment for age, women had lower, comparable, and higher ba-PWV vs men in the NGR, prediabetes, and diabetes groups, respectively. In participants aged 40-59 years, women were associated with lower ba-PWV levels in generally all glycemic strata after adjustment for age and other confounders. In participants aged ≥60 years, women were associated with significantly higher ba-PWV levels (β coefficient = 71.5; 95% confidence interval = 23.4, 119.7) and the sex difference was attenuated in the groups of prediabetes and diabetes with a borderline significant interaction between sex and glycemic status (p for interaction = .068).
Conclusions: The sex difference in cardiovascular risks in adults with NGR, prediabetes, or diabetes was dependent on age. Our findings provide new evidence for prioritizing preventive treatment against atherosclerosis in men vs women with different glycemic status.
背景:研究表明在正常血糖调节(NGR)、糖尿病前期和糖尿病患者中, 女性的心血管风险分别较低、相当和较高。然而, 这种性别差异是不确定的, 年龄可能是原因之一。我们旨在评估NGR、糖尿病前期或糖尿病患者动脉硬化的性别差异, 以及年龄对动脉硬化的潜在影响。 方法:我们使用了上海一项大型社区队列研究中9618名≥40岁参与者的基线数据。血糖状态由糖尿病史、空腹和餐后2h血糖水平以及糖化血红蛋白水平决定。肱-踝动脉脉搏波传导速度(ba-PWV)检测动脉硬化水平。采用多变量线性回归分析检验性别、血糖、年龄与ba-PWV之间的关系。 结果:在校正年龄前, 在NGR组、糖尿病前期组和糖尿病组中, 女性的ba-PWV分别比男性低、相当和高。在40-59岁的参与者中, 在校正年龄和其他混杂因素后, 女性在所有血糖水平分类中的ba-PWV水平都较低。在≥60岁的参与者中, 女性的ba-PWV水平显著升高(β=71.5, 95%可信区间=23.4,119.7), 性别差异在糖尿病前期和糖尿病组中减弱, 性别和血糖状态之间存在接近显著的交互作用(P相互 =0.068)。 结论:在患有NGR、前驱糖尿病或糖尿病的成年人中, 心血管风险的性别差异取决于年龄。我们的发现为优先预防不同血糖状态的男性和女性动脉粥样硬化提供了新的证据。.
Keywords: age; arterial stiffness; glycemic status; sex difference; 动脉硬化指数; 年龄; 性别差异; 血糖状态.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.