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50 Cardio Diabetes Medicine 2017

ic female controls. This data confirms that diabetes, diabetic female patients. The INTERHEART study of
even at an early stage, attenuates the protective ef- risk factors for CVD identified diabetes mellitus as
fect of female sex and increases the risk for CVD in one of the greatest risk factor for women, as diabetic
females to a greater extent than in males. women had a threefold to fourfold increased risk of
developing CVD compared to men. (4)

Sex differences in symptoms of IHD
*) women report more angina despite lower rate of
obstructive CAD.
*) Meta analysis of 74 reports from 13,311 women and
11511 men, prevalence of angina is 11% to 27% greater
for women less than 65yrs.
*) women have lesser obstructive CAD regardless of
symptoms and continue to have signs and symptoms
of ischemia, repeat hospitalization, consumption of
health care resources.
Studies demonstrate under-treatment of women with
medication compared with men. Both studies also
show gender differences in use of procedures. While
increasing knowledge exists regarding pathophysio-
logical mechanistic pathways for “female-pattern”
ischemic HD, translational studies aimed at devel-
oping practical diagnosis and therapeutics with both
traditional and novel treatments are needed.
Fig-1
Coagulation
Pathophysiology Diabetic women had a higher prothrombotic fibrin
Hyperglycemia inhibits antiproliferative effects of profile, with denser fibrin clots and prolonged fibri-
estrogen on vascular smooth muscle cells. These nolysis. In men only, worse glycemic control was
are mediated through selective ERα activation under related to an increased atherothrombotic risk. An in-
normoglycemic conditions. Hence, beneficial effects dividualized therapy strategy might be needed with
are counterbalanced by simultaneous ERβ activation, more aggressive antithrombotic therapy in diabetic
leading to loss of protective estrogen effects. This women and other higher risk groups.
causes a proinflammatory environment accelerating
atherosclerotic processes and CVD particularly in di- Cardiomyopathy
abetic women. Males tend to suffer more often of heart failure at
younger age due to CVD. They are also more likely to
develop myocardial dilatation, whereas women tend
to develop hypertrophic cardiomyopathy with diastol-
ic heart failure and preserved ejection fraction more
often. Diabetic females feature greater susceptibility
to diabetic cardiopathology besides CHD. They show
greater wall thickness and left ventricular (LV) mass
in relation to glycemic control and diastolic dysfunc-
tion. This more closely relates to IGT, which is more
relevant in women.

Stroke

Fig-2 The excess risk of stroke associated with diabetes is
significantly higher in women than men, independent
The Nurses’ Health Study found CVD mortality in of sex differences in other major cardiovascular risk
women with DM to be 8.7 times higher than in non-

GCDC 2017