DYSLIPIDEMIA AND ISCHEMIC-HEART-DISEASE MORTALITY AMONG MEN AND WOMENWITH DIABETES

Background We investigated whether the greater increased risk of ische mic heart disease mortality associated with diabetes among women compa red with men could be explained by their more pronounced lipoprotein a bnormalities. Methods and Results Seventy-six men and 45 women with di abetes and 327 men and 496 women without diabetes were followed for an average of 16 years in a population-based study. Cox proportional haz ards models were used to determine the relative hazard of ischemic hea rt disease mortality for changes in lipoprotein subfractions after adj ustment for age, hypertension, obesity, smoking, exercise, alcohol con sumption, and estrogen use (among women). The relative hazard of ische mic heart disease mortality among diabetic women was 1.76 (P=.10) for a 10-mg/dL decrement in high-density lipoprotein cholesterol (HDL-C) a nd 3.13 (P=.01) for a 1-U increment in log, very-low-density lipoprote in cholesterol (VLDL-C). The risk of ischemic heart disease mortality among diabetic women relative to nondiabetic women for an HDL-C level of 50 mg/dL and a log, VLDL-C of 3 (about 20 mg/dL) were 4.1 and 3.4, respectively (P<.05). These lipoprotein changes were not associated wi th ischemic heart disease mortality among men or among nondiabetic wom en. Conclusions Excess ischemic heart disease mortality among diabetic women is partially explained by deleterious levels of HDL-C and VLDL- C. HDL-C levels of less than or equal to 50 mg/dL and VLDL-C levels of greater than or equal to 20 mg/dL appear to predict ischemic heart di sease mortality among these women and may help identify women who woul d benefit most from intervention.