Gender difference in baroreflex sensitivity to predict cardiac and cerebrovascular events in type 2 diabetic patients

Abstract

Background: Cardiovascular autonomic neuropathy is a major complication in patients with diabetes mellitus (DM), and baroreflex sensitivity (BRS) reportedly can predict cardiovascular prognosis in type 2 DM patients. The hypothesis that cardiovascular events are associated with gender differences in BRS was tested in the present study. Methods and Results: From 1998, we have evaluated BRS by phenylephrine methods in 185 consecutive type 2 DM patients. The long-term prognostic value of BRS was compared between 91 female (58±12 years) and 94 male patients (58±11 years). There was no significant difference in age or severity and duration of DM between the 2 groups. When compared to male, the BRS value in female patients was significantly lower (9.26±6.0 vs. 5.97±5.0 ms/mmHg, P<0.0001). During a mean of 62.7 months of follow-up, 16 female patients developed cardiovascular events (17.6%) including stroke, acute myocardial infarction, angina pectoris requiring percutaneous coronary intervention or coronary artery bypass grafting and congestive heart failure requiring admission, while only 4 male patients developed events (4.3%, P<0.005). In females, the Kaplan-Meier curves revealed that those with depressed BRS (<6 ms/mmHg) had a higher incidence of cardiovascular events than those with preserved BRS (P<0.05), but this relationship was not observed in male patients. Conclusions: Although the reason why females had a more depressed BRS remains unclear, our findings demonstrated that a depressed BRS value can accurately predict cardiovascular events, especially in female patients with type 2 DM.