Women with type 2 diabetes more likely to develop heart disease

Women with type 2 diabetes more likely to develop heart disease

Dallas County diabetes prevalence surpasses Texas, U.S. rates

While men and women generally have similar rates of type 2 diabetes, women with diabetes are twice as likely to have coronary heart disease and may need more intense physical activity to lower their risk of heart attack or stroke than women without diabetes.

A recent scientific statement issued by the American Heart Association (AHA) and published in the association’s journal Circulation, indicates that risk factors for heart disease and stroke affect women differently from men, and that there are gender disparities in how risk factors are treated.

The recent statement could be especially important for Dallas County, where the diabetes rate is higher than the state or national rates.
Type 2 diabetes occurs when blood glucose levels rise, either because of lack of insulin or the body’s inability to use insulin efficiently. Poor diet and lack of physical activity are among the common risk factors for developing type 2 diabetes. The disease affects an estimated 12.6 million women and 13 million men age 20 and older in the United States.

“We’ve known for years that women die at a disproportionate rate, especially in older years, from heart disease and that the rate is especially high for women with type 2 diabetes. What we haven’t known is the level of that disproportionate rate, when compared to men,” said Shawna Nesbitt, MD, Medical Director of the Hypertension Clinic at Parkland Health & Hospital System and Associate Professor of Internal Medicine - Hypertension, The University of Texas Southwestern Medical Center.

Dr. Nesbitt said that while it is commonly known that women are more protected against heart disease prior to menopause than men, that changes when type 2 diabetes enters the picture.

The recent AHA statement notes that women with type 2 diabetes:

  • have heart attacks at earlier ages than men
  • are more likely to die after a first heart attack than men
  • are less likely to undergo procedures to open clogged arteries, such as angioplasty or coronary artery bypass grafting than men
  • are less likely to be on cholesterol lowering drugs such as statins, take aspirin or use blood pressure-lowering medications than men
  • are less likely to have their blood sugar or blood pressure under control than men
  • develop type 2 diabetes based on sex-specific differences, such as gestational diabetes and polycystic ovary syndrome

The AHA statement also notes that African-American and Hispanic women with type 2 diabetes are disproportionately affected by coronary artery disease and stroke as compared to men with the disease. Women may need to exercise more frequently and more intensely in order to reduce their risk factors, the AHA concluded. 

Diabetes is the seventh leading cause of death in the U.S. And while diabetes is a national concern, the disease is even more prevalent in Texas and in Dallas County. Diabetes affects about 10 percent of the population in Texas, while more than 11 percent of Dallas County residents have the disease. The national average is 9 percent.

“Clearly, having a diagnosis of type 2 diabetes increases the risk of a heart attack or stroke for anyone,” said Luigi Meneghini, MD, executive director of the Global Diabetes Program at Parkland and Professor of Internal Medicine at UT Southwestern. “It is becoming clear that while more men experience cardiovascular events and deaths, a diagnosis of diabetes eliminates the protection women may have against heart disease before menopause. In these women with diabetes, the risk of a heart attack and dying from that heart attack is relatively higher than for men experiencing the same events.”

Dr. Meneghini said the AHA statement highlights opportunities for providing better care for these women through more effective preventive treatments such as use of statin drugs to lower cholesterol, aspirin for prevention of a heart attack, and better blood pressure and diabetes control.

“Both providers and women affected by diabetes need to be more proactive in seeking out appropriate lifestyle and dietary modifications and ensuring that the various risk factors contributing to heart disease and stroke are effectively addressed,” Dr. Meneghini said.

Authors of the AHA statement said that while the new information indicates a difference between women and men, more research needs to be done, especially into why women react differently than men to some medications, and why the risk of death from coronary heart disease is higher among minorities.