Cardiovascular Risk in Women and Men With Type 2 Diabetes and Abdominal Fat

woman injecting insulin
Type 2 diabetes carries a higher risk of associated cardiovascular disease in women than in men. Researchers sought a connection between the higher cardiovascular risk in women and levels of abdominal and intraorgan fat before and after weight loss.

The differences in cardiovascular risk between men and women who have type 2 diabetes (T2D) may be due to different triacylglycerol turnover rates. These findings were published in Diabetologia.

Data for this study were sourced from the Diabetes Remission Clinical Trial (DiRECT). Patients with diabetes (n=64) were assessed for metabolic heath by magnetic resonance imaging and for biochemical and cardiovascular disease (CVD) risk during a period of dietary weight loss at baseline, 5, 12, and 24 months. Data were compared with a group of healthy controls (n=25).

The T2D and control cohorts were aged mean 52.3±1.0 and 55.8±1.2 years, the men:women ratios were 30:34 and 13:12, and BMI was 35.1±0.6 and 29.7±0.8 kg/m2, respectively.

Among the controls, liver fat in women was 22% of that found in men (median, 1.0% vs 4.5%; P =.005) and pancreas fat was 62% of that in men (mean, 4.7% vs 7.6%; P <.001). These trends were not observed among the diabetic cohort for either liver (median, 11.9% vs 16.4%; P =.57) or pancreas (mean, 8.3% vs 8.5%; P =.83) fats.

Among women, those with diabetes had a higher mean hepatic VLDL1-triacylglycerol (VLDL1-TG) rates than controls (mean, 559.3 vs 403.2 mg/kg-1/day-1; P =.01). For men, there was an 8% higher rate among the diabetic group (mean, 548.8 vs 506.7 mg/kg-1/day-1; P =.40). Among the T2D group, fasting plasma VLDL1-TG levels were 63% lower among women (median, 0.45 vs 0.72 mmol/L; P =.014) and for controls, 50% lower among women (median, 0.25 vs 0.50 mmol/L; P =.008).

Visceral adipose tissue was observed to be 71% lower among women with diabetes compared with men and 32% lower among nondiabetic women compared with men. Risk for CVD was 14.7% among men with diabetes and 10.2% among women with diabetes (P =.049) compared with 7.3% and 4.4% (P =.021) among controls, respectively.

Heart age among men (mean, 57.9±2.0 years) and women (mean, 69.1±1.2 years; P <.0001) with diabetes was higher than men (mean, 59.5±2.1 years) and women (mean, 67.8±1.2 years; P =.003) without diabetes, despite similar actual ages.

For the T2D group, absolute weight loss was lower in women than men (mean, -12.9±1.2 vs -17.5±1.4 kg; P =.02); fewer women achieved diabetic remission (65.4% vs 71.0%). Changes to liver fat were similar among men and women (1.3% vs 1.8%; P <.0001) as were VLDL1-TG production rates (mean, 417.7 vs 474.6 mg/kg-1/day-1; P =.001). Men had significant decreases in plasma VLDL1-TG (median, 0.72 to 0.23 mmol/L; P =.0001) but women did not.

This study may have been biased as the patients with T2D remained substantially overweight despite considerable weight loss and were not expected to have normal metabolism.

The study authors concluded that there were major differences in metabolism between men and women and among controls and patients with T2D alike. These differences may, in part, contribute to the significant and differential CVD risk and outcomes between men and women with T2D.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Jesuthasan A, Zhyzhneuskaya S, Peters C, et al. Sex differences in intraorgan fat levels and hepatic lipid metabolism: implications for cardiovascular health and remission of type 2 diabetes after dietary weight loss. Diabetologia. Published online October 16, 2021. doi:10.1007/s00125-021-05583-4