Diabetes strongest risk factor for premature CHD risk in women
medwireNews: Analysis of the Women’s Health Study shows that diabetes is more strongly associated with risk for premature coronary heart disease (CHD) than any other clinical risk factor or biomarker.
Having diabetes was associated with a 10.71-fold increased risk for developing premature CHD (before the age of 55 years) during a median 21.4 years of follow-up, after accounting for factors including ethnicity and educational level.
Diabetes was also linked to a 10.92-fold increased risk for developing CHD at the age of 55–64 years, but the risk increase was attenuated in older participants, with diabetes associated with a 4.49-fold and 3.47-fold increased risk for CHD in women aged 65–74 years and 75 years or older, respectively.
This age-related attenuation of risk was observed for almost all risk factors, which included BMI categories, smoking status, hypertension, and parental early-onset myocardial infarction, plus a range of lipid, metabolic, and inflammatory biomarkers.
This “should not, however, imply that risk factors are more important at younger vs older ages,” write Samia Mora (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and study co-authors in JAMA Cardiology.
Instead, the findings “emphasize the need for improved primary prevention among younger women,” they say.
The team’s analysis included 28,024 participants,1548 (5.5%) of whom developed CHD. Of the clinical risk factors, obesity, hypertension, metabolic syndrome, and current smoking were also significantly associated with premature CHD, with risk increases ranging from 3.92- to 6.09-fold.
“The study findings underscore the importance of diabetes and insulin resistance as major determinants of premature CHD, as well as other modifiable major risk factors that can be addressed with lifestyle or preventive interventions,” say the researchers.
All inflammatory biomarkers assessed were significantly associated with risk for premature CHD, as were most lipid measures.
However, Mora and team note that the magnitudes of the associations between lipids and CHD were less than those for the lipoprotein insulin resistance (LPIR) measure.
They explain that this measure is based on lipoprotein subfractions as a correlate of insulin resistance according to HOMA-IR, and has previously been linked to diabetes incidence, irrespective of statin therapy.
LPIR was more strongly associated with premature CHD than any other lipid, inflammatory, or metabolic measure, including glycated hemoglobin, and, moreover, the association was only slightly attenuated after accounting for pre-existing diabetes.
“The LPIR score potentially links insulin resistance and its concomitant atherogenic dyslipoproteinemia with future risk of both diabetes and premature CHD,” suggest the researchers, adding that further study of this risk factor is needed.
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