SEX-DIFFERENCES IN COAGULATION AND FIBRINOLYSIS IN WHITE SUBJECTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

The increase in cardiovascular risk associated with having non-insulin -dependent diabetes mellitus (NIDDM) is far greater in women than men. Conventional risk factors do not account for this excess, and attenti on has focused on the possible contribution of abnormalities of fibrin olysis and coagulation in NIDDM. In the general population a number of hemostatic factors have been shown to predict the occurrence or progr ession of coronary artery disease. To investigate sex differences in c oagulation and fibrinolysis in NIDDM, we measured levels of fibrinogen , factor VII:C, von Willebrand factor, plasminogen activator inhibitor -1, and tissue plasminogen activator in 213 NIDDM subjects (124 men an d 89 women) who were not receiving insulin therapy. The women had high er levels of factor VII:C (144% versus 120.5% in men, P<.0005) and pla sminogen activator inhibitor-1 activity (25.6 versus 17.0 U/mL), and t hese differences remained significant when account was taken of the hi gher body mass index (29.6 versus 28.0 kg/m(2), P=.02), glycosylated h emoglobin (7.2% versus 6.5%, P<.05), and cholesterol levels (6.3 versu s 5.7 mmol/L, P<.0005) in women than men. In contrast, levels of fibri nogen (3.2 versus 3.1 g/L), tissue plasminogen activator antigen (10.6 versus 11.2 ng/mL), and von Willebrand factor (1.27 versus 1.23 IU/mL ) were no different between women and men, respectively. These results suggest that elevated levels of plasminogen activator inhibitor-1 and factor VII:C may contribute to the increased cardiovascular risk of N IDDM that is particularly marked in women.