Young women are typically at lower risk for heart disease than men of the same age. But if you have diabetes, your risk may be the same as men—a 4-fold increase compared to women without diabetes, according to a new study.
“Our findings suggest that we need to work harder to prevent heart disease in women under 60 years of age who have diabetes,” said Rita Rastogi Kalyani, MD, MHS, endocrinologist at the Johns Hopkins University School of Medicine in Baltimore, Maryland, and lead author of the study. “This study tells us that women of any age who have diabetes are at a high risk for coronary artery disease [CAD],” she told OnTrack Diabetes.
“In general, people who have diabetes are classified as having the same overall risk for CAD as someone who has known CAD,” noted Tara Narula, MD, FACC, Associate Director, Cardiac Care Unit Lenox Hill Hospital/North Shore LIJ, in New York, NY and a member of the American Heart Association Advocacy Committee. “Thus, we need to be more aggressive in treating our diabetes patients in general and specifically, as this study points out, we probably need to be more aggressive in how we treat younger women with diabetes,” Dr. Narula said.
The findings of the study, reported online ahead of print in Diabetes Care, are timely given the recent updated cholesterol treatment guidelines by the American Heart Association’s (AHA). AHA now recommend that people with type 1 or type 2 diabetes who are 40 to 75 years old with a low-density lipoprotein (LDL, bad cholesterol) level of 70 to 189 mg/dL should receive statins, medications used to reduce cholesterol levels.
“This study looked at women younger than 60, so certainly women with diabetes who are between 40 and 60 years old should be treated with cholesterol lowering medications and specifically with a statin class of agent based on the new guidelines,” Dr. Narula explained to OnTrack Diabetes.
A remaining question is how young to target therapy. Should younger women with diabetes in their 20s and 30s be targeted? While this practice is not recommended in the AHA guidelines, the decision should be made between the physician and patient on an individualized basis until more information is available, added Dr. Narula.
In practice, uniformly prescribing statins to every person with diabetics above 40 and with no other cardiovascular risk factors is not necessarily agreed upon, noted Dr. Kalyani. However, It is important to screen and treat other CVD risk factors in patients with diabetes of any age, she noted.
Researchers are studying the possible causes of this increased risk. One theory is that differences in genetic and hormone differences between men and women contribute to the development of CAD. Another cause may be differences in lifestyle behaviors, medication compliance, and intensity of diabetes treatment, but further research is needed, Dr. Kalyani said. Also, the relationship between how long you have had diabetes and your blood sugar (glucose) control to the risk of heart disease remains unclear.
Women with diabetes, at any age, should have a thorough physical. If you have are found to have risk factors for heart disease, than aggressive treatment should involve treating all of the risk factors for CAD, Dr. Narula said. The first step is to control blood sugar and hemoglobin A1C as well as possible. “The recommendation for A1C level is <7% and we know that the lower you push it, the better it is for heart health. For each 1% decrease in A1C level equals an almost 40% decrease in the rate of microvascular events [kidney and eye disease],” she said.
“Secondly we know that high blood pressure increases the risk for cardiovascular events. Women with diabetes should have their blood pressure monitored very carefully, and if elevated, treated to less than 140/80 mmHg,” Dr. Narula said. Other steps include cholesterol management as already described, smoking cessation, and counseling on weight loss and exercise.