Diabetes associated with higher risk of cardiovascular problems in men

According to a new study by researchers at Brigham and Women's Hospital (BWH), men with type 2 diabetes treated with insulin without a history of cardiovascular disease (CVD) were at higher risk for major cardiovascular events (e.g., death, heart attack, stroke) compared with men who had a history of CVD.

The study is being presented at the American College of Cardiology 2012 Annual Scientific Session, March 24 to 26 in Chicago.

Using data from the global REACH Registry, researchers evaluated the magnitude of risk of diabetes mellitus on cardiovascular events in both men and women. Risk was estimated in men and women separately independent of patient age, ethnicity, and other cardiovascular risk factors.

Among the 64,000 eligible REACH patients, the four-year risk of major cardiovascular events (death, heart attack or stroke) increased incrementally in patients with diabetes treated with diet only, oral diabetes medications or insulin.

Male patients with type 2 diabetes treated with insulin but without prior CVD were a particular high-risk group, with an accelerated rate of new cardiovascular events compared to their female counterparts.

For instance, men with diabetes taking insulin had a 16 percent rate of major cardiovascular events over four years. Whereas, men with prior CVD without diabetes had a lower rate for these cardiovascular events, similar to women with diabetes taking insulin and women without diabetes but with prior CVD (about 13 percent).

The researchers concluded that men with diabetes taking insulin had a 70 percent increased risk for a first cardiovascular event compared to men with a known history of CVD having a recurrent event.

In addition, men with diabetes taking insulin were at a 40 percent higher risk than women.

Lower-risk patients (those with diabetes not taking insulin) and very high-risk patients (those with both diabetes and CVD) had no apparent gender-risk differences.

"These findings suggest that both men and women with diabetes with severe insulin resistance (those patients requiring insulin) are at high risk for cardiovascular events, as high risk as patients who already have established cardiovascular disease," said Jacob Udell, MD, Cardiovascular Division, BWH Department of Medicine, and lead study investigator. "Given that the number of patients diagnosed with type 2 diabetes requiring insulin continues to increase, these patients require diligent cardiovascular risk factor management to potentially avoid a first cardiovascular event."

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This research was supported by the Canadian Institutes for Health Research, Canadian Foundation for Women's Health, Sanofi-Aventis, Bristol-Myers Squibb, Waksman Foundation (Tokyo), and the World Heart Federation.

Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is the home of the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), www.brighamandwomens.org/research, BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 900 physician-investigators and renowned biomedical scientists and faculty supported by more than $537 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative.