Effect of type 1 diabetes on the gender difference in coronary artery calcification: a role for insulin resistance? The Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study.
The objective of this is study was to examine whether estimated insulin resistance and insulin resistance-related factors are associated with coronary artery calcification (CAC) in 1,420 asymptomatic participants in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. A total of 656 patients with type 1 diabetes and 764 control subjects aged 20-55 years were examined. CAC was assessed by electron-beam computed tomography. Insulin resistance was computed with linear regression based on an equation previously validated in clamp studies on type 1 diabetic adults. Insulin resistance was associated with CAC (OR 1.6 in type 1 diabetes and 1.4 in control subjects, P < 0.001), independent of coronary artery disease risk factors. There was a male excess of CAC in control subjects (OR 2.7, adjusted for age, smoking, and LDL and HDL cholesterol levels) and in type 1 diabetic patients (OR 2.2, adjusted for the same factors and diabetes duration). After adjusting for insulin resistance, the CAC male excess in diabetic patients decreased from OR 2.2 (P < 0.001) to 1.8 (P = 0.04). After adjustment for waist-to-hip ratio, waist circumference, or visceral fat, the gender difference in CAC was not significant in diabetic subjects. In conclusion, gender differences in insulin resistance-associated fat distribution may explain why type 1 diabetes increases coronary calcification in women relatively more than in men.
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. dana.dabelea@uchsc.edu
Dana
D
Dabelea
Gregory
G
Kinney
Janet K
JK
Snell-Bergeon
John E
JE
Hokanson
Robert H
RH
Eckel
James
J
Ehrlich
Satish
S
Garg
Richard F
RF
Hamman
Marian
M
Rewers
D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012016:Reference Values; D012727:Sex Characteristics; D014057:Tomography, X-Ray Computed