Sex Differences in Coronary Artery Calcium and Mortality from Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults with Diabetes: The Coronary Calcium Consortium
Research Design and Methods: We studied adults with DM from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality endpoints.
Results: Among 4,503 adults with DM (32.5% women) aged 21-93 years, 61.2% of women and 80.4% of men had CAC>0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC>100. Age and risk factor-adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total (1.36 vs. 1.21) and CVD mortality (1.67 vs. 1.33) (interaction p=0.01 for both) but similar for CHD mortality (1.53 and 1.48). For CVD mortality, HR’s with CAC scores of 101-400 and >400 were 3.67 and 6.27, respectively for women and 1.63 and 3.48, respectively for men (interaction p=0.04). For total mortality HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction p=0.01).
Conclusion: CAC predicts CHD, CVD, and all-cause mortality in patients with DM; however, greater CAC predicts CVD and total mortality more strongly in women.