Yeo Jian L, Dattani Abhishek, Bilak Joanna M, Wood Alice L, Athithan Lavanya, Deshpande Aparna, Singh Anvesha, Arnold J Ranjit, Brady Emer M, Adlam David, Biglands John D, Kellman Peter, Xue Hui, Yates Thomas, Davies Melanie J, Gulsin Gaurav S, McCann Gerry P
Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
Radiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
J Cardiovasc Magn Reson. 2024 Dec 6;27(1):101132. doi: 10.1016/j.jocmr.2024.101132.
Coronary microvascular dysfunction (CMD) is a significant complication in type 2 diabetes (T2D) and may be more common in women. We aimed to evaluate the sex differences and sex-specific clinical determinants of CMD in adults with T2D without prevalent cardiovascular disease.
Single center pooled analysis of four prospective studies comparing asymptomatic people with T2D and controls. All subjects underwent comprehensive cardiovascular phenotyping with myocardial perfusion reserve (MPR) quantified with perfusion cardiovascular magnetic resonance (CMR). Participants with silent coronary disease were excluded. Multivariable linear regression was performed to identify determinants of MPR with an interaction term for sex.
Four hundred and seventy-nine T2D (age 57 ± 11 years, 42% [202/479] women) were compared with 116 controls (age 53 ± 11 years, 41% [48/116] women). Men with T2D, but not women, demonstrated worse systolic function and higher extracellular volume fraction than controls. MPR was significantly lower in T2D than controls (women, 2.6 ± 0.9 vs 3.3 ± 1.0, p < 0.001; men, 3.1 ± 0.9 vs 3.5 ± 1.0, p = 0.004), and lower in women than men with T2D (p < 0.001). More women than men with T2D had MPR <2.5 (46% [79/202] vs 26% [64/277], p < 0.001). There was a significant interaction between sex and body mass index (BMI) for MPR (p interaction <0.001). Following adjustment for clinical risk factors, inverse association with MPR were BMI in women (β = -0.17, p = 0.045) and systolic blood pressure in men (β = -0.14, p = 0.049).
Among asymptomatic adults with T2D, women had a greater prevalence of CMD than men. Risk factors modestly but significantly associated with CMD in asymptomatic people with T2D were BMI among women and systolic blood pressure among men.
冠状动脉微血管功能障碍（CMD）是2型糖尿病（T2D）的一种重要并发症，在女性中可能更为常见。我们旨在评估无心血管疾病病史的T2D成年患者中CMD的性别差异及性别特异性临床决定因素。
对四项前瞻性研究进行单中心汇总分析，比较无症状T2D患者与对照组。所有受试者均接受了全面的心血管表型分析，通过灌注心血管磁共振成像（CMR）对心肌灌注储备（MPR）进行量化。排除患有隐匿性冠心病的参与者。进行多变量线性回归分析，以确定MPR的决定因素，并加入性别交互项。
将479例T2D患者（年龄57±11岁，42%[202/479]为女性）与116例对照组（年龄53±11岁，41%[48/116]为女性）进行比较。患有T2D的男性，而非女性，与对照组相比表现出更差的收缩功能和更高的细胞外容积分数。T2D患者的MPR显著低于对照组（女性：2.6±0.9 vs 3.3±1.0，p<0.001；男性：3.1±0.9 vs 3.5±1.0，p=0.004），且患有T2D的女性MPR低于男性（p<0.001）。患有T2D且MPR<2.5的女性多于男性（46%[79/202] vs 26%[64/277]，p<0.001）。MPR在性别和体重指数（BMI）之间存在显著交互作用（p交互<0.001）。在调整临床危险因素后，女性的BMI（β=-0.17，p=0.045）和男性的收缩压（β=-0.14，p=0.049）与MPR呈负相关。
在无症状的T2D成年患者中，女性CMD的患病率高于男性。在无症状的T2D患者中，与CMD适度但显著相关的危险因素在女性中是BMI，在男性中是收缩压。
