Pre-diabetes increases the likelihood of cardiovascular disease, and women tend to experience more adverse effects.
Association Between Elevated Blood Glucose and Increased Cardiovascular Disease Risk, Particularly Pronounced in Women”
Researchers have found that even when blood glucose levels are below the threshold for diagnosing diabetes, there is a heightened risk of cardiovascular disease (CVD). This risk is exacerbated in women, and it can largely be attributed to modifiable factors such as obesity and the lower prescription rates of antihypertensive medicines and statins.
Utilizing data from the UK Biobank study, experts examined the connection between varying blood glucose levels and the risk of developing conditions such as coronary artery disease, atrial fibrillation, deep vein thrombosis, pulmonary embolism, stroke, heart failure, or any form of cardiovascular disease (CVD).
The study encompassed 427,435 individuals aged 40-69 years and revealed a 30-50% heightened risk of CVD in those with pre-diabetes (HbA1c 42-27mmol/mol), undiagnosed diabetes (48mmol/mol or higher), and diagnosed diabetes, when compared to those without the condition.
However, a more nuanced analysis indicated distinct gender disparities. Men with elevated blood glucose levels below the diabetes threshold faced a 30% increased risk of developing CVD. In contrast, women in the same category experienced a 30-50% higher CVD risk, as detailed in findings published in The Lancet Regional Health – Europe.
Nevertheless, the increased CVD risk for women relative to men was mitigated once variables such as body mass index, waist-to-hip ratio, and medication usage were considered. Notably, women had lower usage rates of antihypertensive medications and statins compared to men, particularly within the normal and pre-diabetic ranges.
For instance, among men with pre-diabetes, 37.8% were prescribed statins, and 41.6% were on antihypertensive medication. The corresponding figures for women in the same category were 26.9% and 36%.
Regarding individuals within the ‘normal’ blood glucose range (up to 41mmol/mol), the evidence strongly suggested that lower levels offer better protection against cardiovascular disease.
The researchers emphasize the necessity for an investigation into the reasons behind this “prescribing gap” between men and women. This concern arises as the most recent data reveals a surge of 16 million in the number of prescribed drug items for diabetes since 2015/16. Concurrently, the cost of anti-diabetic medications has surged by 107% during the same timeframe, according to the NHS Business Services Authority.
This development coincides with the UK witnessing the diabetes patient count exceeding 5 million for the first time earlier this year, as cautioned by a report from Diabetes UK.
Dr. Christopher Rentsch, the lead author affiliated with the London School of Hygiene and Tropical Medicine, commented, “We assessed disparities in heart disease risk between genders across the entire spectrum of blood sugar levels. What we ascertained was that these risks extend beyond individuals with diagnosed diabetes; individuals with prediabetes, both men and women, are also considerably impacted. Our research additionally presents compelling proof that maintaining a lower blood sugar level within the ‘normal’ range appears to offer superior protection against heart disease.”
Professor Krishnan Bhaskaran, a co-author of the study, contributed, “Our findings imply that the escalated risks observed in both men and women might be alleviated through modifiable elements, including strategies for weight reduction and an increased utilization of antihypertensive and statin medications.”
Dr. Stephen Lawrence, a General Practitioner and Associate Clinical Professor at the University of Warwick, remarked that the study raises a range of intriguing questions, even though it draws its observations from a population that is healthier compared to the average UK population.
“This is an exceedingly captivating observational study. As an illustration, based on my experience, when you assess the implementation of QRISK, it tends to underestimate the risk for women.”
He further noted that women appear to require a more substantial increase in weight compared to men in order to trigger a biochemical shift towards diabetes.
“The data strongly imply that a more assertive emphasis on risk factors is necessary when prescribing for women with diabetes. However, this emphasis shouldn’t solely be on prescription but should also extend to lifestyle considerations.”
