Liver, pancreatic fat may underlie ‘disproportionately raised’ CV risk in women with diabetes
medwireNews: Women naturally have lower levels of hepatic and pancreatic fat than men, but having type 2 diabetes removes this advantage and confers a relatively larger increase in cardiovascular (CV) risk, show further data from DiRECT.
Therefore, “weight loss and remission of diabetes are of particular importance for cardiovascular health in women,” presenter Ahmad Al-Mrabeh (Newcastle University, UK) told attendees at the virtual 2021 Diabetes UK Professional Conference.
He reported that levels of liver and pancreatic fat were significantly lower in 12 women who did not have diabetes than in 13 men. And while production of very-low-density lipoprotein (VLDL)-triglyceride was similar in both sexes, women had significantly lower fasting plasma levels than men.
The presenter said this is likely because women store VLDL-triglyceride more effectively in their subcutaneous adipose tissue than men do, which minimizes the proportion that ends up in the liver and pancreas.
He noted that men are more susceptible than women to developing type 2 diabetes, but among those living with the condition, women have a higher CV risk than men.
The sex differences in liver and pancreatic fat were lost in 30 women and 34 men with type 2 diabetes from the Tyneside cohort of DiRECT; levels of both were markedly higher than in control women, while liver fat levels only were increased in men. This was despite women retaining significantly lower fasting plasma VLDL-triglyceride levels than men.
Al-Mrabeh suggested this could be because women who develop type 2 diabetes have reached “maximal storage capacity” for triglyceride-rich lipids in their fat, or because of “dysfunction in the biology of adipose tissues.”
When these women and men with diabetes lost weight over the course of DiRECT, they experienced similar reductions in liver and pancreatic fat, and in VLDL-triglyceride production. However, only men had a significant reduction in fasting plasma levels of VLDL-triglyceride, along with a significantly larger reduction in total triglycerides.
Women with diabetes had significantly higher levels of non-esterified fatty acids than men did, and only women experienced a reduction in line with diet-induced weight loss.
Nevertheless, both women and men benefitted from weight loss in terms of reducing their 10-year CV risk (based on QRISK score), with the largest benefit seen in those whose diabetes remitted and did not relapse.
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