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Markus, M.R.P.* ; Ittermann, T.* ; Schipf, S.* ; Bahls, M.* ; Nauck, M.* ; Völzke, H.* ; Santos, R.D.* ; Peters, A. ; Zeller, T.* ; Felix, S.B.* ; Vasan, R.S.* ; Thorand, B. ; Steinhagen-Thiessen, E.* ; Dörr, M.*

Association of sex-specific differences in lipoprotein(a) concentrations with cardiovascular mortality in individuals with type 2 diabetes mellitus.

Cardiovasc. Diabetol. 20:168 (2021)
Publ. Version/Full Text DOI PMC
Open Access Gold
Creative Commons Lizenzvertrag
Background: Compared to individuals without type 2 diabetes mellitus, the relative increase in cardiovascular mortality is much higher in women than in men in individuals with type 2 diabetes mellitus. Methods: We evaluated data from 7443 individuals (3792 women, 50.9%), aged 20 to 81 years, from two independent population-based investigations, SHIP-0 and MONICA/KORA S3. We analyzed the longitudinal sex-specific associations of lipoprotein(a) with cardiovascular mortality in individuals with and without type 2 diabetes mellitus using Cox regression. Results: During a median follow-up of 20.5 years (136,802 person-years), 657 participants (404 men and 253 women) died of cardiovascular causes. Among individuals without type 2 diabetes mellitus, men had a significantly higher risk for cardiovascular mortality compared to women in unadjusted model and after adjustment. On the other hand, in participants with type 2 diabetes mellitus, the risk for cardiovascular mortality was not different between men and women in the unadjusted model and after adjustment for age, body mass index, low-density lipoprotein-cholesterol, fasting status and study sample (SHIP-0, MONICA/KORA S3). Further adjustment for lipoprotein(a) concentrations had no impact on the hazard ratio (HR) for cardiovascular mortality comparing men versus women in individuals without type 2 diabetes mellitus [HR: 1.94; 95% confidence interval (CI) 1.63 to 2.32; p < 0.001]. In individuals with type 2 diabetes mellitus, however, further adjustment for lipoprotein(a) led to an increased risk for cardiovascular mortality in men and a decreased risk in women resulting in a statistically significant difference between men and women (HR: 1.53; 95% CI 1.04 to 2.24; p = 0.029). Conclusions: Women are described to have a stronger relative increase in cardiovascular mortality than men when comparing individuals with and without type 2 diabetes mellitus. Higher lipoprotein(a) concentrations in women with type 2 diabetes mellitus than in men with type 2 diabetes mellitus might partially explain this finding.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Cardiovascular Mortality ; Dyslipidemia ; Lipoprotein(a) ; Sex-specific ; Type 2 Diabetes Mellitus; Coronary-heart-disease; Myocardial-infarction; Insulin-resistance; Metabolic Syndrome; Risk-factor; 64 Cohorts; Men; Health; Population; Impact
ISSN (print) / ISBN 1475-2840
e-ISSN 1475-2840
Journal Cardiovascular Diabetology
Quellenangaben Volume: 20, Issue: 1, Pages: , Article Number: 168 Supplement: ,
Publisher BioMed Central
Publishing Place Campus, 4 Crinan St, London N1 9xw, England
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology II (EPI2)
Grants State of Bavaria
German Competence Network Heart Failure
German Federal Ministry of Education and Research (BMBF)
Helmholtz Zentrum Munchen (German Research Center for Environmental Health) - German Federal Ministry of Education and Research (BMBF)
European Union
German Federal Ministry of Education and Research
Brazilian National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico; CNPq), Brazil
Evans Medical Foundation
Jay and Louis Coffman Endowment from the Department of Medicine, Boston University School of Medicine
Projekt DEAL