Effect of Type 1 diabetes on the gender difference in Coronary Artery calcification: a role for insulin resistance? The Coronary Artery Calcification in Type 1 diabetes (cacti) study

• Published in: Diabetes (New York, N.Y.) Vol. 52; no. 11; pp. 2833 - 2839
• Main Authors: DABELEA, Dana, KINNEY, Gregory, SNELL-BERGEON, Janet K, HOKANSON, John E, ECKEL, Robert H, EHRLICH, James, GARG, Satish, HAMMAN, Richard F, REWERS, Marian
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.11.2003
• Subjects: Adult; Age Factors; Associated diseases and complications; Biological and medical sciences; Body Mass Index; Calcification; Calcification (Physiology); Calcinosis - diagnostic imaging; Calcinosis - epidemiology; Calcinosis - physiopathology; Coronary Disease - diagnostic imaging; Coronary Disease - epidemiology; Coronary Disease - physiopathology; Diabetes Mellitus, Type 1 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - physiopathology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Hypertension - epidemiology; Insulin Resistance; Male; Medical sciences; Middle Aged; Physiological aspects; Prevalence; Reference Values; Sex Characteristics; Sex differences (Biology); Tomography, X-Ray Computed; Type 1 diabetes; Endocrinopathy; Immunopathology; Target tissue resistance; Pancreatic hormone; Type 1 diabetes; Coronary artery; Calcification; Autoimmune disease; Insulin
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/diabetes.52.11.2833

The objective of this is study was to examine whether estimated insulin resistance and insulin resistance-related factors are associated with coronary artery calcification (CAC) in 1,420 asymptomatic participants in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. A total of 656 patients with type 1 diabetes and 764 control subjects aged 20-55 years were examined. CAC was assessed by electron-beam computed tomography. Insulin resistance was computed with linear regression based on an equation previously validated in clamp studies on type 1 diabetic adults. Insulin resistance was associated with CAC (OR 1.6 in type 1 diabetes and 1.4 in control subjects, P < 0.001), independent of coronary artery disease risk factors. There was a male excess of CAC in control subjects (OR 2.7, adjusted for age, smoking, and LDL and HDL cholesterol levels) and in type 1 diabetic patients (OR 2.2, adjusted for the same factors and diabetes duration). After adjusting for insulin resistance, the CAC male excess in diabetic patients decreased from OR 2.2 (P < 0.001) to 1.8 (P = 0.04). After adjustment for waist-to-hip ratio, waist circumference, or visceral fat, the gender difference in CAC was not significant in diabetic subjects. In conclusion, gender differences in insulin resistance-associated fat distribution may explain why type 1 diabetes increases coronary calcification in women relatively more than in men.