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Diabetes, Insulin Resistance Are the Strongest Risk Factors for Premature Coronary Heart Disease in Women
January 20, 2021

In a cohort study that included 28,024 women, diabetes and insulin resistance appeared to be the strongest risk factors for premature onset of coronary heart disease (CHD).

The findings were published in JAMA Cardiology.

“In this cohort study, associations of most risk factors with coronary heart disease attenuated with increasing age at onset,” wrote Sagar B. Dugani, MD, Mayo Clinic, Rochester, Minnesota, and colleagues. “Of more than 50 clinical and biomarker risk factors examined, diabetes and lipoprotein insulin resistance had the highest relative risk, particularly for premature coronary heart disease.”

The researchers analysed approximately 50 biomarkers associated with cardiovascular health in 28,024 women aged 45 years or older without known cardiovascular disease who were participating in the Women’s Health Study. Women were followed for a median of 21.4 years.

Of the clinical factors in the women, diabetes had the highest adjusted hazard ratio (aHR) for CHD onset at any age, ranging from 10.71 at CHD onset in those aged younger than 55 years to 3.47 in those aged 75 years or older.

Risks that were also noted for CHD onset in participants aged younger than 55 years included metabolic syndrome (aHR = 6.09), hypertension (aHR = 4.58), obesity (aHR = 4.33), and smoking (aHR = 3.92).

From approximately 50 biomarkers, lipoprotein insulin resistance had the highest standardised aHR (6.40) for CHD onset in women aged younger than 55 years, attenuating with age. In comparison, weaker but significant associations with CHD in women younger than 55 years were noted (per SD increment) for low-density lipoprotein cholesterol (aHR = 1.38), non-high-density lipoprotein cholesterol (aHR = 1.67), apolipoprotein B (aHR = 1.89), and triglycerides (aHR = 2.14) -- all attenuating with age.

“In otherwise healthy women, insulin resistance, type-2 diabetes, and its sister diagnosis, metabolic syndrome, were major contributors to premature coronary events,” said coauthor Samia Mora, MD, Brigham and Women’s Hospital, and Harvard University, Boston, Massachusetts. “Women under 55 who have obesity had about a 4-fold increased risk for coronary events, as did women in that age group who smoked or had hypertension. Physical inactivity and family history are all part of the picture as well.”

The researchers acknowledged the study is limited in its generalizability due to the fact that most (95%) women in the study were white. According to Dr. Mora, the findings could be even more dramatic in ethnic and racial groups that have a greater prevalence of metabolic syndrome, insulin resistance, and diabetes.

“Prevention is better than cure, and many risk factors for heart disease are preventable,” said Dr. Dugani. “This study shows the impact that lifestyle has on heart health in women of all ages, and younger women in particular.”

Reference: https://jamanetwork.com/journals/jamacardiology/article-abstract/2775559

SOURCE: Brigham and Women’s Hospital