Loss of Gender Difference in HDL-Cholesterol in Diabetic Women during Acute Stress

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 807-838-Diabetes - Diagnosis, Complications & Outcomes
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-817
Kristina Djekic*1 and Eli Ipp2
1Western University of Health Sciences, Pomona, CA, 2Los Angeles Biomedical Research Institute at Harbor-UCLA Med Ctr, Torrance, CA
The mechanism for the gender difference in HDL cholesterol (HDL-C) and its regulation are not well understood. The role of estrogen has been questioned - higher HDL-C in women is maintained after menopause, and is unaffected by exogenous estrogen treatment. We therefore evaluated whether the gender difference is also maintained in an alternate clinical model of HDL-C regulation, during rapid fluctuations in HDL-C that occur with acute stress, i.e., admission to hospital. Diabetic patients with metabolic decompensation (n=179) were studied in the fasting state within 24 hours of admission and again at outpatient follow-up. Median (IQR) age was 45 (33, 53) yrs and diabetes duration was 3.0 (0, 10) yrs. The population was predominately minority, 78% either Hispanic or African American. During admission, fasting lipid concentrations were not different in females (F, n=88) and males (M, n=91). Total cholesterol (total-C) was 188 (149, 223) and 182 (147, 224) mg/dl for F and M; triglycerides (TG) 167 (104, 233) vs. 166 (85, 333) mg/dl; LDL-C was 113 (79, 145) vs. 100 (75, 125), and HDL-C 36 (28, 45) vs. 35 (30, 43) mg/dl. Glycemic control was also similar; A1C was 12.9% (10.8, 14.3) in F vs. 12.7% (11.4, 14.3) in M. At follow-up, after a median 4.4 (2.0, 9.5) and 3.9 (2.3, 7.8) months in F and M respectively (p=0.39), the change in TG, LDL-C and total-C from baseline admission values was not different between F and M. TG decreased by 23 (-81, 42) vs. 25 (-195, 17) mg/dl; LDL-C increased by 4 (-32, 29) vs. 4 (-27, 27) mg/dl in F and M, respectively. Total-C increased by 12 (-30, 55) in F vs. 2 (-54, 33) mg/dl in M (p=0.06). In contrast, HDL-C increased in both F and M, but with a significant greater increase in F, 11 (4, 23) vs. 6 (-1, 15) mg/dl (p<0.003). This increase restored the gender-based difference in fasting HDL-C, 48 (39, 61) and 41 (36, 49) mg/dl in F and M at follow-up (p=<0.002). A1C improved similarly in each group, with a decrease of 3.8% (6.3, 1.2) in F vs. 4.4% (6.6, 1.5) in M. We conclude that the gender difference in HDL-C levels is lost at the time of admission to hospital in patients with diabetes, and returns at outpatient follow-up, when acute stress has resolved. Though apparently temporary in nature, these results raise the possibility that recurrent episodes of acute severe stress in F may lead to cumulative loss of the HDL-C advantage usually conferred on females, including the long term cardioprotection that this entails.

Nothing to Disclose: KD, EI

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