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. 2008 Jul 15;102(2):150-4.
doi: 10.1016/j.amjcard.2008.03.029. Epub 2008 May 9.

Diabetes mellitus, hypothalamic hypoestrogenemia, and coronary artery disease in premenopausal women (from the National Heart, Lung, and Blood Institute sponsored WISE study)

Bina Ahmed  1 , C Noel Bairey Merz, B Delia Johnson, Vera Bittner, Sarah L Berga, Glenn D Braunstein, T Keta Hodgson, Karen Smith, Leslee Shaw, Sheryl F Kelsey, George Sopko; WISE Study Group
Affiliations

Diabetes mellitus, hypothalamic hypoestrogenemia, and coronary artery disease in premenopausal women (from the National Heart, Lung, and Blood Institute sponsored WISE study)

Bina Ahmed et al. Am J Cardiol. .

Abstract

Diabetes mellitus (DM) portends a higher risk of coronary heart disease mortality in women compared with men. This relationship appears to be independent of traditional cardiac risk factors, and the role of reproductive hormones has been postulated. We assessed the relationship between DM, hypothalamic hypoestrogenemia (HHE), angiographic coronary artery disease (CAD), and major adverse cardiovascular events (MACE) during a median of 5.9 years in premenopausal women enrolled in the WISE Study. We evaluated 95 premenopausal women from WISE who underwent coronary angiography for suspected ischemia and were not using exogenous reproductive hormones. Results showed no difference in age between women with (n = 30) and without (n = 65) DM (43 +/- 6 years). DM was associated with hypertension, HHE, angiographic CAD, and coronary artery severity score (all p <0.05). Women with DM were twice as likely to have HHE (50% vs 26%; p = 0.02) compared with women without DM. The presence of both DM and HHE was associated with increased prevalence (40% vs 12% or 13%; p = 0.006) and severity of angiographic CAD (coronary artery severity score 19.9 +/- 19.2 vs 7.7 +/- 4.6 or 12.3 +/- 18.8; p = 0.008) compared with either HHE or DM alone, respectively. DM was moderately predictive of MACE. In conclusion, in premenopausal women undergoing coronary angiography for suspected myocardial ischemia, DM was associated with HHE. The presence of both DM and HHE predicted a greater burden of angiographic CAD. Prospective research is warranted to better understand causal relations between DM, endogenous hormones, and MACE in premenopausal women.

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Conflict of interest statement

None of the work represents a conflict of interest and there are no financial relationships to disclose among the coauthors.

Figures

Figure 1
Figure 1
Prevalence of Angiographic Coronary Artery Disease Stratified by Diabetes and Hypothalamic Hypoestrogenemia Status. (CAD=coronary artery disease; DM= diabetes mellitus; HHE= hypothalamic hypoestrogenemia)
Figure 2
Figure 2
Diabetes, Hypothalamic Hypoestrogenemia and Major Adverse Cardiac Events Hazard Ratios, 95% Confidence Intervals, and p-values. (DM= diabetes mellitus; HHE= hypothalamic hypoestrogenemia; MACE= major adverse cardiac event)
Figure 3
Figure 3
Proposed mechanistic interplay between premature estrogen deficiency, diabetes mellitus and atherogenesis.
See this image and copyright information in PMC

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