Cardiovascular risk in women with type 2 diabetes

An estimated 16 million people in the United States have diabetes, 90% to 95% of whom have type 2 diabetes mellitus (DM). Cardiovascular disease (CVD) is the most common cause of death in the United States, and CVD mortality is even more common in men and women with type 2 DM. In fact, 50% to 75% of people with type 2 DM die of CVD. Although the CVD mortality rate in the general population is declining, the reduction is less in individuals with type 2 DM than in nondiabetic individuals. Type 2 DM results in a greater increment in CVD risk in women than in men. The classic risk factors that accompany type 2 DM play a large part in the excess CVD mortality risk in women, yet treatment for both primary and secondary prevention of CVD in women is inadequate. Although the increased CVD risk could be due solely to a greater impact of type 2 DM on CVD risk factors in women compared with men, there may be additional independent risks associated with type 2 DM in women. An understanding of the effects of type 2 DM on CVD risk factors in women is critical if the excess mortality risk is to be minimized. This article describes the increased risk of CVD and of CVD morbidity and mortality among women with type 2 DM, explores the impact of classic and novel CVD risk factors, and summarizes therapeutic strategies in this population.