Alexandra Kautzky-Willer

Giovannella Baggio

Giuseppina T. Russo

Maria Chiara Rossi

International Journal of Endocrinology

Directory of Open Access Journals

Type 2 Diabetes and Cardiovascular Risk in Women

Crossref

EditorialType 2 Diabetes and Cardiovascular Risk in WomenGiuseppina T. Russo,1 Giovannella Baggio,2Maria Chiara Rossi,3 and Alexandra Kautzky-Willer41Dipartimento di Medicina Clinica e Sperimentale, Policlinico Universitario “G. Martino” , Via C. Valeria, 98121 Messina, Italy2Chair of the Gender Medicine, University of Padua, Via Giustiniani 2, 35128 Padua, Italy3Laboratory of Clinical Epidemiology of Diabetes and Chronic Diseases, Fondazione Mario Negri Sud, Via Nazionale 8/A,66030 Santa Maria Imbaro, Italy4Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III,Medical University of Vienna, Wa¨hringer Gu¨rtel 18-20, 1090 Vienna, AustriaCorrespondence should be addressed to Giuseppina T. Russo; giuseppina.russo@unime.itReceived 18 January 2015; Accepted 18 January 2015Copyright © 2015 Giuseppina T. Russo et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.Cardiovascular diseases (CVD) are the leading cause of death,also in diabetic women. Since 1998, when Haffner et al. [1]stated that subjects with type 2 diabetes mellitus (T2DM) hada CVD risk “equivalent” to previous myocardial infarction, alarge number of studies have shown that this relative risk forCVD due to diabetes is greater in women than in men [2].CVD in diabetic subjects is not entirely related to chronichyperglycaemia and a number of other factors such asdyslipidemia, hypertension, hormonal, genetic, and environ-mental factors, as well as low-grade systemic inflammationand endothelial damage, lifestyle behaviours, adherence totherapies, and/or psychosocial factors may contribute to theworst outcomes observed in diabetic women. Notably, itis increasingly recognized that many of these factors showgender differences in their prevalence and/or associationwithCVD events, and this aspect should be specifically targetedwhen aiming at primary or secondary CVD prevention indiabetic subjects.In this special issue, we looked at CVD in womenwith diabetes from different perspectives, giving a greatcontribution to this topic, in terms of mortality, managementof risk factors, and therapies.Two papers of this special issue looked at sex differencesin CVD mortality associated with diabetes. One conductedon a large population-based sample from Italy demonstratedan excess of mortality in diabetic subjects as compared tonondiabetic ones and a greater impact of diabetes in femalesthan in males for mortality for all causes, for CVD, and formyocardial infarction and renal causes. In the other study,G. Luo et al. showed in a retrospective analysis that fastingplasma glucose was an independent predictor of in-hospitalmortality for nondiabetic female patients.Gender-specific prevalence and management of majorand emerging CVD risk factors in different populations werealso the main topic of several papers of this special issue.The paper by S. Chen et al., with a very interesting exper-imental protocol, clarified the relationships of albuminuria,a well-recognized CVD risk factor, with circulating levelsof angiopoietin-1 (Ang-1), Ang-2, and vascular endothelialgrowth factor (VEGF) in serum and urine.Potential gender differences in the distribution and con-trol of major CVD risk factors were investigated in anotherthree very large high-risk populations. Thus, in the eControlStudy, a study on 286,791 patients with T2DM in Catalonia,Spain, J. Franch-Nadal et al. found that cardiometaboliccontrol was worse in subjects with prior CVD; but controlof several risk factors showed gender differences, favouringwomen with prior CVD only for smoking and BP, whereasLDL-cholesterol (LDL-C) levels were remarkably uncon-trolled in women both with and without CVD.The results of an overall bad control of LDL-C in womenwere also demonstrated in a very large Italian diabeticoutpatient population from the Annals Study Initiative. Thisstudy, conducted on 415.294 patients (45.3% women) fromHindawi Publishing CorporationInternational Journal of EndocrinologyVolume 2015, Article ID 832484, 2 pageshttp://dx.doi.org/10.1155/2015/8324842 International Journal of Endocrinology236 diabetes outpatient centers in Italy, demonstrated thatLDL-C management was worst in women with T2DM, whowere monitored and reached targets less frequently than menand, similar to men, did not receive medications despite highLDL-C levels. These gender discrepancies increased with ageand diabetes duration, exposing older women to higher CHDrisk.In accordance with the previously cited studies, also theBARI 2D Trial, in a very high-risk population of T2DMsubjects with established coronary artery disease, found thatalthough women were as aggressively treated with drugsas men, they less frequently met targets for HbA1c andLDL-C, suggesting potential sex differences in response todrug therapies used to treat diabetes, hypertension, andhyperlipidemia.Beyond LDL-C, different papers of this special issuefocused on atherogenic dyslipidemia, that is, the presence oflowHDL-cholesterol (HDL-C), and high triglycerides, whichmay have an impact on CVD especially in diabetic women[3, 4]. K. Song et al. demonstrated, in an in vitro study onprimary hepatocytes of SR-BI knockout (SR-BI−/−) mice,that ATPase-B1 is involved in HDL endocytosis and it maybe a potential target for regulating HDL metabolism.Diabetic women have been demonstrated to have aless atheroprotective HDL subpopulation profile when com-pared to nondiabetic ones [5]. Another study of the specialissue examining HDL subpopulations distribution in thatsame population of CHD-free diabetic and control womenshowed an inverse relationship between markers of systemicinflammation and the more atheroprotective large 𝛼-1, 𝛼-2,and pre𝛽-1 HDL subclasses, especially in diabetic women,suggesting that different HDL particles could affect theatherosclerotic process through themodulation of subclinicalinflammation. A third paper on atherogenic dyslipidemia byJ. He et al. demonstrated gender differences on the discrim-inatory power of triglyceride (TG) and the triglyceride tohigh-density lipoprotein-cholesterol ratio (TG/HDL-C) forinsulin resistance in normoglycaemic Chinese subjects.Furthermore, in normoglycaemic women with previousGDM, Y. Winhofer et al. demonstrated that despite thediagnosis of normal glucose tolerance after delivery, priorGDM women are characterized by persisting subtle glucoseabnormalities and insulin resistance, decreased adiponectin,and increased CRP concentrations, thus exposing them to anincreased CVD risk. Thus women with a history of GDMshould be regarded as high-risk group for development ofovert diabetes andCVD and special attention should be givento preventive measures among these females.Another two articles of this special issue also examinedthe role of estrogen replacement therapy (ERT) or flavonoidson CVD risk factors. Thus, M. Boukhris et al. reviewed thecontroversial role of ERT on CHD in postmenopausal type 2diabetic women, trying to define the place of ERT on CHDprevention, whereas R. D’Anna et al. investigated the effectsof a 6-month treatment of polyphenols, myo-inositol, and soyisoflavones on several CVD risk factors in postmenopausalwomen with metabolic syndrome.Finally, in a very interesting review, E. Satta et al. exploredother aspects of the management of high-risk metabolicwomen, focusing on sexual dysfunctions in women withdiabetic kidney disease and exploring the role of metabolicand hormonal variables and frequently used drugs on thisimportant aspect impacting their quality of life.Even though the papers published in this special issueare profoundly different in topic and study methodologies,they overall underline the importance of sex differenceswhen examining CVD risk factors and their associationwith treatment, outcome, and mortality, especially in T2DMsubjects.Giuseppina T. RussoGiovannella BaggioMaria Chiara RossiAlexandra Kautzky-WillerReferences[1] S. M. Haffner, S. Lehto, T. Ro¨nnemaa, K. Pyo¨ra¨la¨, and M.Laakso, “Mortality from coronary heart disease in subjectswith type 2 diabetes and in nondiabetic subjects with andwithout prior myocardial infarction,”The New England Journalof Medicine, vol. 339, no. 4, pp. 229–234, 1998.[2] A. A. Rivellese, G. Riccardi, and O. Vaccaro, “Cardiovascularrisk in women with diabetes,” Nutrition, Metabolism and Car-diovascular Diseases, vol. 20, no. 6, pp. 474–480, 2010.[3] D. J. Wexler, R. W. Grant, J. B. Meigs, D. M. Nathan, and E.Cagliero, “Sex disparities in treatment of cardiac risk factors inpatients with type 2 diabetes,” Diabetes Care, vol. 28, no. 3, pp.514–520, 2005.[4] A. Juutilainen, S. Kortelainen, S. Lehto, T. Ro¨nnemaa, K.Pyo¨ra¨la¨, and M. Laakso, “Gender difference in the impact oftype 2 diabetes on coronary heart disease risk,” Diabetes Care,vol. 27, no. 12, pp. 2898–2904, 2004.[5] G. T. Russo, K. V. Horvath, A. Di Benedetto, A. Giandalia,D. Cucinotta, and B. Asztalos, “Influence of menopause andcholesteryl ester transfer protein (CETP) TaqIB polymorphismon lipid profile andHDL subpopulations distribution inwomenwith and without type 2 diabetes,” Atherosclerosis, vol. 210, no.1, pp. 294–301, 2010.Submit your manuscripts athttp://www.hindawi.comStem CellsInternationalHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014MEDIATORSINFLAMMATIONofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Behavioural NeurologyEndocrinologyInternational Journal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Disease MarkersHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014BioMed Research InternationalOncologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Oxidative Medicine and Cellular LongevityHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014PPAR ResearchThe Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Journal ofObesityJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014 Computational and  Mathematical Methods in MedicineOphthalmologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Diabetes ResearchJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Research and TreatmentAIDSHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Gastroenterology Research and PracticeHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Parkinson’s DiseaseEvidence-Based Complementary and Alternative MedicineVolume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

http://downloads.hindawi.com/journals/ije/2015/832484.pdf

Type 2 Diabetes and Cardiovascular Risk in Women

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals

Crossref