Sex Differences in Coronary Microvascular Function in Individuals With Type 2 Diabetes.
Sex Differences in Coronary Microvascular Function in Individuals With Type 2 Diabetes.
复制标题
作者：
Haas AV;Rosner BA;Kwong RY;Rao AD;Garg R;Di Carli MF;Adler GK
糖尿病女性患者的心血管（CV）疾病病死率高于男性患者，尽管阻塞性冠状动脉疾病（CAD）的发生率较低。冠状动脉血流储备受损（CFR），即腺苷刺激心肌血流量与静息心肌血流量（MBF）的比值，是冠状动脉微血管功能障碍的指标，可预测重大不良CV事件。我们进行了一项事后分析，以确定在46名男性和27名女性控制良好的2型糖尿病患者中，冠状动脉微血管功能障碍是否存在性别差异，并且没有阻塞性CAD的临床证据。我们发现，与男性相比，女性静息MBF较高，CFR较低，舒张功能较差。此外，女性静息MBF与舒张功能差呈正相关。我们以前的研究表明，盐皮质激素阻滞剂可改善2型糖尿病患者的CFR，提示醛固酮与冠状动脉微血管功能障碍的病理生理有关。因此，我们检查了醛固酮水平，发现女性对血管紧张素II输注的反应比男性更大。总之，在心脏代谢控制良好的2型糖尿病患者中，女性的心肌灌注和舒张功能比男性差。女性更高的醛固酮反应性可能是这种性别效应的一种机制。
Cardiovascular (CV) disease fatality rates are higher for women compared with men with diabetes despite lower rates of obstructive coronary artery disease (CAD). Impaired coronary flow reserve (CFR), the ratio of adenosine-stimulated to rest myocardial blood flow (MBF), is an indicator of coronary microvascular dysfunction and predicts major adverse CV events. We performed a post hoc analysis to determine whether there was a sex disparity in coronary microvascular dysfunction among 46 men and 27 women with well-controlled type 2 diabetes and without clinical evidence of obstructive CAD. We found that women had a higher rest MBF, lower CFR, and worse diastolic function compared with men. In addition, rest MBF was positively correlated with worse diastolic function in women. We previously showed that mineralocorticoid blockade improved CFR in men and women with type 2 diabetes, implicating aldosterone in the pathophysiology of coronary microvascular dysfunction. We therefore examined aldosterone levels and found that women had larger increases in aldosterone in response to an angiotensin-II infusion than did men. In conclusion, among individuals with type 2 diabetes and good cardiometabolic control, women had worse myocardial perfusion and diastolic function compared with men. The greater aldosterone responsivity in women may be a mechanism for this sex effect.
登录
查看更多内容
影响因子：
37.8
作者：
Gupta A;Taqueti VR;van de Hoef TP;Bajaj NS;Bravo PE;Murthy VL;Osborne MT;Seidelmann SB;Vita T;Bibbo CF;Harrington M;Hainer J;Rimoldi O;Dorbala S;Bhatt DL;Blankstein R;Camici PG;Di Carli MF
通讯作者：
Di Carli MF
影响因子：
8.2
作者：
Hu, G;Jousilahti, P;Tuomilehto, J
通讯作者：
Tuomilehto, J
影响因子：
--
作者：
KANNEL, WB;WILSON, PWF
通讯作者：
WILSON, PWF
影响因子：
16.2
作者：
通讯作者：
--
影响因子：
37.8
作者：
Murthy VL;Naya M;Foster CR;Gaber M;Hainer J;Klein J;Dorbala S;Blankstein R;Di Carli MF
通讯作者：
Di Carli MF