Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium

• Published in: Diabetes care Vol. 43; no. 10; pp. 2597 - 2606
• Main Authors: Wong, Nathan D, Cordola Hsu, Amber R, Rozanski, Alan, Shaw, Leslee J, Whelton, Seamus P, Budoff, Matthew J, Nasir, Khurram, Miedema, Michael D, Rumberger, John, Blaha, Michael J, Berman, Daniel S
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.10.2020
• Subjects: Adult; Adults; Aged; Aged, 80 and over; Arteriosclerosis; Calcification (ectopic); Calcium; Calcium - blood; Calcium - metabolism; Cardiovascular and Metabolic Risk; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cause of Death; Consortia; Coronary artery; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - epidemiology; Coronary vessels; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetes Mellitus - mortality; Diabetic Angiopathies - epidemiology; Diabetic Angiopathies - mortality; Female; Gender aspects; Health risks; Heart diseases; Humans; Male; Men; Middle Aged; Mortality; Research design; Risk analysis; Risk Assessment; Risk Factors; Severity of Illness Index; Sex; Sex Characteristics; Sex differences; Time Factors; United States - epidemiology; Vascular Calcification - complications; Vascular Calcification - epidemiology; Women; Young Adult; United States
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc20-0166

While diabetes has been previously noted to be a stronger risk factor for cardiovascular disease (CVD) in women compared with men, whether this is still the case is not clear. Coronary artery calcium (CAC) predicts coronary heart disease (CHD) and CVD in people with diabetes; however, its sex-specific impact is less defined. We compared the relation of CAC in women versus men with diabetes for total, CVD, and CHD mortality. We studied adults with diabetes from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality end points. Among 4,503 adults with diabetes (32.5% women) aged 21-93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor-adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction = 0.01) and CVD mortality (1.47 vs. 1.27) (interaction = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101-400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction = 0.01). CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.