Deaths from heart disease increase in diabetic women
Death rate for men declines slightly
Diabetic women are experiencing a significant increase in heart disease deaths, while mortality from coronary artery disease is declining in the general population, as well as in diabetic men.
In data just released from the First National Health and Nutrition Examination Survey (NHANES I), researchers at the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) in Bethesda, MD, found the age-adjusted heart disease mortality rate increased by 23% from 1971 to 1993 in women with diabetes, while it fell 27% in nondiabetic women during the same period.
The news is better for diabetic men, who saw a 13.1% decline in heart disease deaths over those 22 years, compared to a much larger 36.4% decrease for nondiabetic men.
Lead author Maureen Harris, PhD, MPH, director of the NIDDK’s Diabetes Data Group says the data suggest "diabetic patients, particularly women, may not have benefited from the improvement in heart disease risk factors and better medical treatment for people with coronary artery disease."
She says she hopes to get more information from the NHANES II data that are just becoming available.
Because of the increasing prevalence of diabetes and the recent upsurge in Type 2 diagnoses in younger people, even in children, "we can expect diabetes to become an increasingly important reason for heart disease mortality in this country," Harris says. She adds that 50% of all diabetic deaths are attributed to heart disease.
While it is well recognized that post-menopausal women lose their estrogen protection against heart disease, diabetic women have higher risks. Diabetic heart disease is "a different kind of heart disease. It’s a small vessel disease that is not as amenable to surgical therapy," says Richard Dickey, MD, president of the American Association of Clinical Endocrinologists (AACE) and a practicing endocrinologist in Hickory, NC.
Dickey says the new mortality statistics carry some credence with him because of an often-ignored condition among diabetic women — autonomic neuropathy. Sufferers, most of them women, don’t recognize the pain of a heart condition. It is sometimes called silent angina or silent ischemia and results from damage to the sympathetic and parasympathetic nervous system, resulting in higher heart rates.
"I have seen women who don’t recognize the chest pain. They may not complain at all when they are having a heart attack, and they die without ever having been diagnosed," Dickey says.
AACE guidelines call for 24-hour screenings for silent angina for women who may be at risk, especially if they have signs of diabetic neuropathy elsewhere.
[Maureen Harris can be reached at (301) 594-8801 and Richard Dickey at (828) 322-7338.]
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