Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain.
Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain.
J Clin Endocrinol Metab. 2024 Aug 13;109(9):e1759-e1767. doi: 10.1210/clinem/dgad755.
The excess risk of fatal and nonfatal cardiovascular events is roughly twice as high in women than in men with type 1 diabetes.
To evaluate the impact of preeclampsia and parity on sex-based discrepancies in preclinical atherosclerosis and on the diagnostic performance of a cardiovascular risk scale.
Cross-sectional study.
Single tertiary hospital.
A total of 728 people with type 1 diabetes (48.5% women) without cardiovascular disease and age ≥40 years, nephropathy, and/or ≥10 years of diabetes duration with another risk factor.
Standardized carotid ultrasonography.
Carotid plaque determined by ultrasonography and cardiovascular risk estimated according to the Steno T1 Risk Engine (Steno-Risk).
Nulliparous women and parous women without previous preeclampsia had a lower risk for carotid plaque than men (adjusted odds ratio: .48, 95% confidence interval [.28-.82]; adjusted odds ratio: .51 [.33-.79], respectively), without differences in the preeclampsia group. The prevalence of carotid plaque increased as the estimated cardiovascular risk increased in all subgroups except for preeclampsia group. The area under the curve of the Steno-Risk for identifying ≥2 carotid plaques was lower in the preeclampsia group (men: .7886; nulliparous women: .9026; women without preeclampsia: .8230; preeclampsia group: .7841; P between groups = .042). Neither the addition of parity nor preeclampsia in the Steno-Risk led to a statistically significant increase in the area under the curve.
The risk for carotid plaque in women compared with men decreased as exposure to obstetric factors diminished. However, the addition of these factors did not improve the prediction of the Steno-Risk.
1 型糖尿病患者中，女性致命和非致命心血管事件的风险比男性高出约两倍。
评估子痫前期和生育史对临床前动脉粥样硬化性别差异的影响，以及心血管风险评分的诊断性能。
横断面研究。
单家三级医院。
共纳入 728 例无心血管疾病且年龄≥40 岁、合并肾病和/或糖尿病病程≥10 年且有其他危险因素的 1 型糖尿病患者（48.5%为女性）。
颈动脉超声检查。
颈动脉斑块通过超声检查确定，心血管风险根据 Steno T1 风险引擎（Steno-Risk）进行评估。
未生育的女性和无既往子痫前期的生育女性发生颈动脉斑块的风险低于男性（校正比值比：.48，95%置信区间：.28-.82；校正比值比：.51，95%置信区间：.33-.79），而子痫前期组中无差异。在所有亚组中，除子痫前期组外，随着估计的心血管风险增加，颈动脉斑块的患病率也随之增加。在 Steno-Risk 中，识别出≥2 个颈动脉斑块的曲线下面积在子痫前期组较低（男性：.7886；未生育女性：.9026；无子痫前期女性：.8230；子痫前期组：.7841；组间差异 P =.042）。Steno-Risk 中加入生育史或子痫前期病史并不会使曲线下面积显著增加。
与男性相比，女性的颈动脉斑块风险随着产科因素暴露的减少而降低。然而，加入这些因素并没有改善 Steno-Risk 的预测能力。
