Sex differences and sex steroids influence on the presentation and severity of cardiovascular autonomic neuropathy of patients with type 1 diabetes

Cardiovascular Diabetology

卷:22

Research

Beatriz Dorado Avendaño¹  Lía Nattero-Chávez²  Manuel Luque-Ramírez³  Héctor F. Escobar-Morreale⁴  Alejandra Quintero Tobar⁵  Elena Fernández-Durán⁵  María Insenser⁵  Tom Fiers⁶  Jean-Marc Kaufman⁶ 

[1] Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Carretera de Colmenar, Km 9.1, 28034, Madrid, Spain;

[2] Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Carretera de Colmenar, Km 9.1, 28034, Madrid, Spain;Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain;

[3] Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Carretera de Colmenar, Km 9.1, 28034, Madrid, Spain;Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain;University of Alcalá, Madrid, Spain;

[4] Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Carretera de Colmenar, Km 9.1, 28034, Madrid, Spain;Laboratory for Hormonology and Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium;University of Alcalá, Madrid, Spain;

[5] Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain;

[6] Laboratory for Hormonology and Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium;

关键词: Autonomic nervous system;    Cardiovascular disease;    Cardioautonomic neuropathy;    Sexual dimorphism;    Sex differences;    Sex hormones;    Sex steroids;    Type 1 diabetes mellitus;   

DOI  :  10.1186/s12933-023-01766-y

 received in 2022-11-08, accepted in 2023-02-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSex differences characterize cardiovascular outcomes in patients with type 1 diabetes. Cardioautonomic neuropathy is a common complication of type 1 diabetes that associates increased morbi-mortality. Data regarding the interplay between sex and cardiovascular autonomic neuropathy are scarce and controversial in these patients. We aimed to address sex-related differences in the prevalence of seemingly asymptomatic cardioautonomic neuropathy in type 1 diabetes, and their associations with sex steroids.MethodsWe conducted a cross-sectional study including 322 consecutively recruited patients with type 1 diabetes. Cardioautonomic neuropathy was diagnosed using Ewing's score and power spectral heart rate data. We assessed sex hormones by liquid chromatography/tandem mass spectrometry.ResultsWhen considering all subjects as a whole, asymptomatic cardioautonomic neuropathy prevalence was not significantly different between women and men. When age was taken into account, the prevalence of cardioautonomic neuropathy was similar among young men and those > 50 years. However, in women > 50 years, the prevalence of cardioautonomic neuropathy doubled that of young women [45.8% (32.6; 59.7) vs. 20.4% (13.7; 29.2), respectively]. The OR of having cardioautonomic neuropathy was 3.3 higher in women > 50 years than in their younger counterparts. Furthermore, women presented more severe cardioautonomic neuropathy than men. These differences were even more marked when women were classified according their menopausal status instead of age. Peri- and menopausal women had an OR 3.5 (1.7; 7.2) of having CAN compared with their reproductive-aged counterparts [CAN prevalence: 51% (37; 65) vs. 23% (16; 32), respectively]. A binary logistic regression model (R2: 0.161; P = 0.001) displayed age > 50 years as a significant determinant of cardioautonomic neuropathy only in women. Androgens were positively associated with heart rate variability in men, and negatively in women. Accordingly, cardioautonomic neuropathy was associated with increased testosterone/estradiol ratio in women but to decreased testosterone concentrations in men.ConclusionsMenopause in women with type 1 diabetes is accompanied by an increase in the prevalence of asymptomatic cardioautonomic neuropathy. This age-related excess risk of cardioautonomic neuropathy is not observed in men. Men and women with type 1 diabetes have opposite associations between circulating androgens and indexes of cardioautonomic function.Trial registration ClinicalTrials.gov Identifier:NCT04950634.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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