title: Diabetes mellitus, hypothalamic hypoestrogenemia, and coronary artery disease in premenopausal women (from the National Heart, Lung, and Blood Institute sponsored WISE study).
abstract: Diabetes mellitus (DM) portends a higher risk of coronary heart disease mortality in women compared with men. This relationship appears to be independent of traditional cardiac risk factors, and the role of reproductive hormones has been postulated. We assessed the relationship between DM, hypothalamic hypoestrogenemia (HHE), angiographic coronary artery disease (CAD), and major adverse cardiovascular events (MACE) during a median of 5.9 years in premenopausal women enrolled in the WISE Study. We evaluated 95 premenopausal women from WISE who underwent coronary angiography for suspected ischemia and were not using exogenous reproductive hormones. Results showed no difference in age between women with (n = 30) and without (n = 65) DM (43 +/- 6 years). DM was associated with hypertension, HHE, angiographic CAD, and coronary artery severity score (all p <0.05). Women with DM were twice as likely to have HHE (50% vs 26%; p = 0.02) compared with women without DM. The presence of both DM and HHE was associated with increased prevalence (40% vs 12% or 13%; p = 0.006) and severity of angiographic CAD (coronary artery severity score 19.9 +/- 19.2 vs 7.7 +/- 4.6 or 12.3 +/- 18.8; p = 0.008) compared with either HHE or DM alone, respectively. DM was moderately predictive of MACE. In conclusion, in premenopausal women undergoing coronary angiography for suspected myocardial ischemia, DM was associated with HHE. The presence of both DM and HHE predicted a greater burden of angiographic CAD. Prospective research is warranted to better understand causal relations between DM, endogenous hormones, and MACE in premenopausal women.
authors.affiliation: Department of Medicine, Division of Cardiology, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. bina.ahmed@vtmednet.org
authors.forename: Bina
authors.initials: B
authors.lastname: Ahmed
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Berga
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Braunstein
authors.forename: T Keta
authors.initials: TK
authors.lastname: Hodgson
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.forename: Leslee
authors.initials: L
authors.lastname: Shaw
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: George
authors.initials: G
authors.lastname: Sopko
mesh_terms: D000328:Adult; D000367:Age Factors; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology*; D003331:Coronary Vessels / Q000473:pathology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D004967:Estrogens / Q000172:deficiency*; D005260:Female; D006801:Humans; D007027:Hypothalamic Diseases / Q000503:physiopathology*; D054555:National Heart, Lung, and Blood Institute (U.S.); D017697:Premenopause; D014481:United States / Q000453:epidemiology
chemical_list: D004967:Estrogens