Sex differences in myocardial flow reserve among individuals with type 2 diabetes: insights from the DiaHeart study
Abstract Background Type 2 diabetes is a stronger risk factor for cardiovascular disease (CVD) in women compared with men possibly due to higher susceptibility to develop myocardial microvascular dysfunction. We investigated sex-dependent effects of risk factors on myocardial blood flow (MBF) and my...
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BMC
2025-04-01
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| Series: | Cardiovascular Diabetology |
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| Online Access: | https://doi.org/10.1186/s12933-025-02717-5 |
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| author | Anne-Cathrine Skriver-Møller Philip Hasbak Ida K. B. Rasmussen Martin B. Blond Victor S. Wasehuus Mats C. H. Lassen Morten Lindhardt Allan Kofoed-Enevoldsen Urd L. Kielgast Emilie H. Zobel Jens P. Goetze Lene Holmvang Tor Biering-Sørensen Peter Rossing Andreas Kjaer Rasmus S. Ripa Tine W. Hansen |
| author_facet | Anne-Cathrine Skriver-Møller Philip Hasbak Ida K. B. Rasmussen Martin B. Blond Victor S. Wasehuus Mats C. H. Lassen Morten Lindhardt Allan Kofoed-Enevoldsen Urd L. Kielgast Emilie H. Zobel Jens P. Goetze Lene Holmvang Tor Biering-Sørensen Peter Rossing Andreas Kjaer Rasmus S. Ripa Tine W. Hansen |
| author_sort | Anne-Cathrine Skriver-Møller |
| collection | DOAJ |
| description | Abstract Background Type 2 diabetes is a stronger risk factor for cardiovascular disease (CVD) in women compared with men possibly due to higher susceptibility to develop myocardial microvascular dysfunction. We investigated sex-dependent effects of risk factors on myocardial blood flow (MBF) and myocardial flow reserve (MFR) in individuals with type 2 diabetes without overt CVD. Methods Cross-sectional analysis of a prospective study including 901 individuals recruited between 2020 and 2023. All participants underwent a cardiac 82-Rubidium positron emission tomography/computed tomography scan to quantify MBF at rest and during pharmacologically induced stress, allowing for calculation of MFR. Linear regression, with/without interaction terms for sex, was used to test whether sex modified the association between MFR/MBF and risk factors. Results Mean (SD) age was 65 (8.9) years, diabetes duration was 14 (8.4) years, and 266 (29.5%) were women. Women had higher MBF at rest and stress but had lower MFR (mean (SD) 2.44 (0.67) vs. 2.59 (0.77), p = 0.003) than men. A similar proportion of men and women (21.1% vs. 23.7%) had an MFR < 2. The decline in predicted MFR with age differed between sexes. At age 55, women had a mean MFR that was 0.29 lower than men (95% CI: − 0.44 to − 0.14), but by age 75, this difference had nearly disappeared (− 0.04, 95% CI: − 0.19 to 0.11). However, after adjustment for other risk factors, the interaction between sex and age was not statistically significant (p = 0.057). No other risk factors exhibited significant sex-dependent interactions. Conclusions In individuals with type 2 diabetes without overt CVD, women exhibited lower MFR than men, primarily due to higher MBF at rest, suggesting sex-related differences. While MFR declined in both sexes, the sex difference was more pronounced in younger individuals and diminished over time. These findings underscore the need for further research into sex-specific thresholds for MFR in cardiovascular risk stratification. Graphical abstract |
| format | Article |
| id | doaj-art-41b7855aba0046d399d8979a1bf4248e |
| institution | OA Journals |
| issn | 1475-2840 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | Cardiovascular Diabetology |
| spelling | doaj-art-41b7855aba0046d399d8979a1bf4248e2025-08-20T02:24:26ZengBMCCardiovascular Diabetology1475-28402025-04-0124111410.1186/s12933-025-02717-5Sex differences in myocardial flow reserve among individuals with type 2 diabetes: insights from the DiaHeart studyAnne-Cathrine Skriver-Møller0Philip Hasbak1Ida K. B. Rasmussen2Martin B. Blond3Victor S. Wasehuus4Mats C. H. Lassen5Morten Lindhardt6Allan Kofoed-Enevoldsen7Urd L. Kielgast8Emilie H. Zobel9Jens P. Goetze10Lene Holmvang11Tor Biering-Sørensen12Peter Rossing13Andreas Kjaer14Rasmus S. Ripa15Tine W. Hansen16Steno Diabetes Center CopenhagenDepartment of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - RigshospitaletSteno Diabetes Center CopenhagenSteno Diabetes Center CopenhagenSteno Diabetes Center CopenhagenDepartment of Cardiology, Herlev and Gentofte HospitalDepartment of Internal Medicine, Holbæk HospitalDepartment of Medicine, Zealand University HospitalDepartment of Medicine, Zealand University HospitalSteno Diabetes Center CopenhagenDepartment of Clinical Biochemistry, University of Copenhagen, RigshospitaletDepartment of Cardiology, RigshospitaletSteno Diabetes Center CopenhagenSteno Diabetes Center CopenhagenDepartment of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - RigshospitaletDepartment of Clinical Medicine, University of CopenhagenSteno Diabetes Center CopenhagenAbstract Background Type 2 diabetes is a stronger risk factor for cardiovascular disease (CVD) in women compared with men possibly due to higher susceptibility to develop myocardial microvascular dysfunction. We investigated sex-dependent effects of risk factors on myocardial blood flow (MBF) and myocardial flow reserve (MFR) in individuals with type 2 diabetes without overt CVD. Methods Cross-sectional analysis of a prospective study including 901 individuals recruited between 2020 and 2023. All participants underwent a cardiac 82-Rubidium positron emission tomography/computed tomography scan to quantify MBF at rest and during pharmacologically induced stress, allowing for calculation of MFR. Linear regression, with/without interaction terms for sex, was used to test whether sex modified the association between MFR/MBF and risk factors. Results Mean (SD) age was 65 (8.9) years, diabetes duration was 14 (8.4) years, and 266 (29.5%) were women. Women had higher MBF at rest and stress but had lower MFR (mean (SD) 2.44 (0.67) vs. 2.59 (0.77), p = 0.003) than men. A similar proportion of men and women (21.1% vs. 23.7%) had an MFR < 2. The decline in predicted MFR with age differed between sexes. At age 55, women had a mean MFR that was 0.29 lower than men (95% CI: − 0.44 to − 0.14), but by age 75, this difference had nearly disappeared (− 0.04, 95% CI: − 0.19 to 0.11). However, after adjustment for other risk factors, the interaction between sex and age was not statistically significant (p = 0.057). No other risk factors exhibited significant sex-dependent interactions. Conclusions In individuals with type 2 diabetes without overt CVD, women exhibited lower MFR than men, primarily due to higher MBF at rest, suggesting sex-related differences. While MFR declined in both sexes, the sex difference was more pronounced in younger individuals and diminished over time. These findings underscore the need for further research into sex-specific thresholds for MFR in cardiovascular risk stratification. Graphical abstracthttps://doi.org/10.1186/s12933-025-02717-5Sex-differencesType 2 diabetesMicrovascular complicationsCardiovascular imaging |
| spellingShingle | Anne-Cathrine Skriver-Møller Philip Hasbak Ida K. B. Rasmussen Martin B. Blond Victor S. Wasehuus Mats C. H. Lassen Morten Lindhardt Allan Kofoed-Enevoldsen Urd L. Kielgast Emilie H. Zobel Jens P. Goetze Lene Holmvang Tor Biering-Sørensen Peter Rossing Andreas Kjaer Rasmus S. Ripa Tine W. Hansen Sex differences in myocardial flow reserve among individuals with type 2 diabetes: insights from the DiaHeart study Cardiovascular Diabetology Sex-differences Type 2 diabetes Microvascular complications Cardiovascular imaging |
| title | Sex differences in myocardial flow reserve among individuals with type 2 diabetes: insights from the DiaHeart study |
| title_full | Sex differences in myocardial flow reserve among individuals with type 2 diabetes: insights from the DiaHeart study |
| title_fullStr | Sex differences in myocardial flow reserve among individuals with type 2 diabetes: insights from the DiaHeart study |
| title_full_unstemmed | Sex differences in myocardial flow reserve among individuals with type 2 diabetes: insights from the DiaHeart study |
| title_short | Sex differences in myocardial flow reserve among individuals with type 2 diabetes: insights from the DiaHeart study |
| title_sort | sex differences in myocardial flow reserve among individuals with type 2 diabetes insights from the diaheart study |
| topic | Sex-differences Type 2 diabetes Microvascular complications Cardiovascular imaging |
| url | https://doi.org/10.1186/s12933-025-02717-5 |
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