Sex-Specific Blood Pressure Trajectories and Cardiovascular Disease in Type 1 Diabetes: 32-Year Follow-up of the Pittsburgh Epidemiology of Diabetes Complications Cohort
Authors' conclusion
BP was lower in women than men, and the strength of its association with the initial manifestation of CVD differed by sex. Further research into sex-specific BP mechanisms is needed to improve CVD risk reduction in people living with type 1 diabetes.
Study context
- Population
- People with T1D without cardiovascular disease (CVD) at baseline, Pittsburgh Epidemiology of Diabetes Complications cohort; Blood pressure (BP) measured up to nine (median six) times 1986–1988 to 2016–2018
- Participants
- 300 vs 304
- Exposure
- Women vs men
- Womenn = 300
- Menn = 304reference
- Outcome
- Sex differences in longitudinal BP and CVD incidence (total CVD, MACE, hard CAD)
- Follow-up
- Followed until December 2020
Methodological details32-year follow-up, joint models adjusted for time-varying antihypertensive (AH) medication use, HbA1c, overt nephropathy, baseline age and other CVD risk factors
- 32-year follow-up
- Joint models adjusted for time-varying AH medication use, HbA1c, overt nephropathy, baseline age and other CVD risk factors
Main finding
As reported in the abstract
Difference in longitudinal systolic BP (SBP)
5.8 mmHg
P < 0.0001
lower in women
Difference in longitudinal diastolic BP (DBP)
6.2 mmHg
P < 0.0001
lower in women
Difference in DBP decline
−0.3 mmHg/year
P < 0.0001
faster decline in women
Observational data: associations, not effects.
Further findings
Major adverse cardiovascular events (MACE) per 5-mmHg increment in longitudinal SBP, men
- HR
- 1.23 (1.04, 1.45) (95% CI)
- Associated with MACE in men only
MACE per 5-mmHg increment in longitudinal DBP, men
- HR
- 1.56 (1.20, 2.04) (95% CI)
- Associated with MACE in men only
Hard CAD per 5-mmHg increment in longitudinal DBP, women
- HR
- 1.28 (1.05, 1.56) (95% CI)
- Associated with hard coronary artery disease (hCAD) in women only
Original publication
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