Department of Primary Care and Population Health, UCL Medical School, Hampstead Campus, Rowland Hill St, London, NW3 2PF, UK.
Diabetologia. 2012 Jan;55(1):80-7. doi: 10.1007/s00125-011-2284-4. Epub 2011 Aug 23.
AIMS/HYPOTHESIS: Type 2 diabetes is associated with greater relative risk of CHD in women than in men, which is not fully explained by conventional cardiovascular risk factors. We assessed whether cardiovascular risk factors including more novel factors such as markers of insulin resistance, inflammation, activated coagulation and endothelial dysfunction differ more between diabetic and non-diabetic women than between diabetic and non-diabetic men, and the role of insulin resistance.
A cross-sectional study of non-diabetic and diabetic men and women (n = 7,529) aged 60-79 years with no previous myocardial infarction who underwent an examination was conducted. Measurements of anthropometry, blood pressure and fasting measurements of lipids, insulin, glucose and haemostatic and inflammatory markers were taken.
Non-diabetic women tended to have more favourable risk factors and were less insulin resistant than non-diabetic men, but this was diminished in the diabetic state. Levels of waist circumference, BMI, von Willebrand factor (VWF), WBC count, insulin resistance (HOMA-IR), diastolic blood pressure, HDL-cholesterol, tissue plasminogen activator (t-PA) and factor VIII differed more between diabetic and non-diabetic women than between diabetic and non-diabetic men (test for diabetes × sex interaction p < 0.05). The more adverse effect of diabetes on these risk markers in women was associated with, and thereby largely attenuated by, insulin resistance.
CONCLUSIONS/INTERPRETATION: The greater adverse influence of diabetes per se on adiposity and HOMA-IR and downstream blood pressure, lipids, endothelial dysfunction and systemic inflammation in women compared with men may contribute to their greater relative risk of coronary heart disease.
目的/假设：2 型糖尿病与女性冠心病的相对风险比男性更高，这不能完全用传统心血管危险因素来解释。我们评估了心血管危险因素，包括胰岛素抵抗、炎症、激活的凝血和内皮功能障碍等更新型的标志物，在糖尿病女性和非糖尿病女性之间的差异是否大于糖尿病男性和非糖尿病男性之间的差异，以及胰岛素抵抗的作用。
对 7529 名年龄在 60-79 岁、无既往心肌梗死的非糖尿病和糖尿病男性和女性进行了一项横断面研究。测量了人体测量学、血压和空腹血脂、胰岛素、血糖以及止血和炎症标志物。
非糖尿病女性的危险因素更有利，胰岛素抵抗程度低于非糖尿病男性，但在糖尿病状态下这种情况有所减少。腰围、BMI、血管性血友病因子（VWF）、白细胞计数、胰岛素抵抗（HOMA-IR）、舒张压、HDL-胆固醇、组织型纤溶酶原激活物（t-PA）和因子 VIII 在糖尿病女性和非糖尿病女性之间的差异大于糖尿病女性和非糖尿病男性之间的差异（糖尿病×性别交互作用检验 p<0.05）。这些风险标志物在女性中受糖尿病影响更大，与胰岛素抵抗有关，因此在很大程度上被其削弱。
结论/解释：与男性相比，糖尿病本身对女性肥胖和 HOMA-IR 以及下游血压、血脂、内皮功能障碍和全身炎症的不良影响更大，这可能导致其冠心病的相对风险更高。
