Men and women with prediabetes, undiagnosed diabetes, and, notably, diagnosed diabetes were at higher risk of incident cardiovascular disease (CVD), whereas those with low-normal A1C were at lower risk of this in a large, 12-year observational study of UK Biobank data.
The results highlight “the need for strategies to reduce risk of CVD across the [glycemic] spectrum,” urges Christopher T. Rentsch, MPH, Ph.D., and colleagues in their study, which was published August 11 in The Lancet Regional Health Europe.
The findings suggest “that excess [CVD] risks in both men and women were largely explained by modifiable factors and could be ameliorated by attention to weight reduction strategies and greater use of antihypertensive and statin medications.
“Addressing these risk factors could reduce sex disparities in [glycemia]-related risks of CVD,” according to the researchers.
After accounting for age, the absolute rate of CVD events was higher among men than women (16.9 vs 9.1 events per 1000 person-years); however, the relative risk was higher among women than men. Compared to men, women were more likely to have obesity (63% vs. 53%) and were less likely to be using antihypertensive medications (64% vs. 69%) or statin (71% vs. 75%).
“This is the largest study to date to investigate sex differences in the risk of CVD across the glycemic spectrum,” say the researchers.
“The Lower the Better”
“We uncovered compelling evidence that for blood sugar levels within the ‘normal’ range, it was a case of ‘the lower the better’ in protecting against heart disease,” Rentsch, assistant professor of pharmacoepidemiology, London School of Hygiene and Tropical Medicine, United Kingdom, told Medscape in an email.
Compared to people with normal blood glucose levels, those with lower than normal levels were at 10% lower risk of developing any form of heart disease, he noted.
The study findings “support women being proactive in asking about medications like statins and antihypertensive as an option to help lower their [CVD] risk, if clinically appropriate,” Rentsch added. “We found that men and women with diagnosed diabetes remained at elevated risk for three types of heart disease — coronary artery disease, stroke, and heart failure — even after accounting for a large number of sociodemographic, lifestyle, and clinical characteristics,” he pointed out.
However, “total cholesterol, family history of CVD, estimated glomerular filtration rate, and C-reactive protein had relatively little impact on explaining the risk of heart disease associated with blood sugar.” “It is well established that being overweight can lead to higher blood sugar levels as well as higher blood pressure, these being factors that contribute to a higher risk of heart attack and stroke,” Robert Storey, DM, professor of cardiology, University of Sheffield, United Kingdom, told the UK Science Media Centre.
