Vascular complications are a leading cause of morbidity and mortality in both men and women with type 1 (T1DM) or type 2 (T2DM) diabetes mellitus, however the prevalence, progression and pathophysiology of both microvascular (nephropathy, neuropathy and retinopathy) and macrovascular [coronary heart disease (CHD), myocardial infarction, peripheral arterial disease (PAD) and stroke] disease are different in the two sexes. In general, men appear to be at a higher risk for diabetic microvascular complications, while the consequences of macrovascular complications may be greater in women. Interestingly, in the absence of diabetes, women have a far lower risk of either micro- or macro-vascular disease compared with men for much of their lifespan. Thus, the presence of diabetes confers greater risk for vascular complications in women compared with men and some of the potential reasons, including contribution of sex hormones and sex-specific risk factors are discussed in this review. There is a growing body of evidence that sex hormones play an important role in the regulation of cardiovascular function. While estrogens are generally considered to be cardioprotective and androgens detrimental to cardiovascular health, recent findings challenge these assumptions and demonstrate diversity and complexity of sex hormone action on target tissues, especially in the setting of diabetes. While some progress has been made toward understanding the underlying mechanisms of sex differences in the pathophysiology of diabetic vascular complications, many questions and controversies remain. Future research leading to understanding of these mechanisms may contribute to personalized- and sex-specific treatment for diabetic micro- and macro-vascular disease.
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May 2017
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Image demonstrates the ultrastructural cortical basement membrane changes in SHRSP brain: accumulation of lipofuscin in pericytes. For further details, see article by Screiber et al in this issue (pages 1001–1013). Image kindly provided by Stefanie Schreiber.
Review Article|
April 19 2017
Sex differences in micro- and macro-vascular complications of diabetes mellitus
Christine Maric-Bilkan
1Division of Cardiovascular Sciences, Vascular Biology and Hypertension Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, U.S.A.
Correspondence: Christine Maric-Bilkan ([email protected])
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Publisher: Portland Press Ltd
Received:
December 30 2016
Revision Received:
January 24 2017
Accepted:
January 25 2017
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© 2017 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society
2017
Clin Sci (Lond) (2017) 131 (9): 833–846.
Article history
Received:
December 30 2016
Revision Received:
January 24 2017
Accepted:
January 25 2017
Citation
Christine Maric-Bilkan; Sex differences in micro- and macro-vascular complications of diabetes mellitus. Clin Sci (Lond) 1 May 2017; 131 (9): 833–846. doi: https://doi.org/10.1042/CS20160998
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