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Review
. 2019 Jan 16;8(1):98.
doi: 10.3390/jcm8010098.

Impact of Sex Differences and Diabetes on Coronary Atherosclerosis and Ischemic Heart Disease

Rosalinda Madonna  1   2 , Carmela Rita Balistreri  3 , Salvatore De Rosa  4 , Saverio Muscoli  5 , Stefano Selvaggio  6 , Giancarlo Selvaggio  7 , Péter Ferdinandy  8   9 , Raffaele De Caterina  10
Affiliations
Review

Impact of Sex Differences and Diabetes on Coronary Atherosclerosis and Ischemic Heart Disease

Rosalinda Madonna et al. J Clin Med. .

Abstract

Cardiovascular diseases (CVD) including coronary artery disease (CAD) and ischemic heart disease (IHD) are the main cause of mortality in industrialized countries. Although it is well known that there is a difference in the risk of these diseases in women and men, current therapy does not consider the sexual dimorphism; i.e., differences in anatomical structures and metabolism of tissues. Here, we discuss how genetic, epigenetic, hormonal, cellular or molecular factors may explain the different CVD risk, especially in high-risk groups such as women with diabetes. We analyze whether sex may modify the effects of diabetes at risk of CAD. Finally, we discuss current diagnostic techniques in the evaluation of CAD and IHD in diabetic women.

Keywords: biomarkers; cell signaling; coronary artery disease; diabetes; gender; sex; women.

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Conflict of interest statement

P.F. is a founder and CEO of Pharmahungary Group, a group of R&D companies.

Figures

Figure 1
Figure 1
Molecular pathways associated with diabetic macroangiopathy. The figure depicts some of the key points discussed in the text on the role of advanced end products (AGE) products, innate immunity, and reactive oxygen species generation in diabetic macroangiopathy. Abbreviations: RAGE, receptor for advanced glycation end products; AGEs, advanced glycation endproducts; TLR, Toll-Like Receptor; HMGB1, high mobility group box 1; IL, interleukin; TNF-α, tumor necrosis factor alpha; MCP-1, Monocyte chemoattractant protein-1; VCAM-1 vascular cell adhesion molecule 1; ICAM-1, intercellular adhesion molecule 1; ROS, reactive oxygen species; ox-LDL, oxidized low-density lipoprotein; NADPH, nicotinamide adenine dinucleotide phosphate; NO, nitric oxyde; eNOS, endothelial nitric oxide synthase.
Figure 2
Figure 2
Noninvasive assessment of coronary artery disease in diabetic women. Although the risk of heart disease in diabetic women may emerge before menopause, detection and evaluation of CAD are difficult, due to the lower sensitivity and specificity of biomarker assays in women.
See this image and copyright information in PMC

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