Study Finds Strong Link Between Diabetes, Premature Coronary Heart Disease in Women

With increasing rates of diabetes and its risk factors, the researchers emphasized the urgency of developing effective interventions.

Investigators have found a new biomarker of insulin resistance, which is linked to a 600% increase in the risk of premature coronary heart disease in women, according to a press release on the study.

The study authors noted that although deaths related to heart disease in older people have declined, they have remained stagnant or even increased slightly among younger patients. To investigate factors that put younger individuals at risk of premature coronary heart disease (CHD), investigators from Brigham and Women’s Hospital and the Mayo Clinic analyzed more than 50 risk factors among 28,024 women who participated in the Women’s Health Study.

They found that women under 55 years of age with type 2 diabetes had a 10 times greater risk of having CHD over the next 2 decades. Furthermore, lipoprotein insulin resistance (LPIR) was a strong, predictive biomarker, according to the study.

“We’re going to see, unfortunately, younger and younger people having heart attacks,” said corresponding author Samia Mora, MD, MHS, in a press release. “When a younger individual has a cardiovascular event, it will affect their quality of life going forward, their productivity, and their contribution to society.”

The team analyzed approximately 50 biomarkers associated with cardiovascular health, finding that commonly used metrics, such as low-density lipoprotein (LDL) cholesterol and hemoglobin A1C, had weaker associations with CHD onset in women younger than 55 years of age. Conversely, LPIR had significantly strong associations and is a newer metric, according to the authors.

LPIR uses a weighted combination of 6 lipoprotein measures and is analyzed through specialized laboratory testing. Whereas LDL cholesterol was only associated with a 40% increased risk of CHD onset in women under 55 years of age, LPIR demonstrated a 600% increase.

“In otherwise healthy women, insulin resistance, type 2 diabetes and its sister diagnosis, metabolic syndrome, were major contributors to premature coronary events,” Mora said. “Women under 55 who have obesity had about a fourfold-increased risk for coronary events, as did women in that age group who smoked or had hypertension. Physical inactivity and family history are all part of the picture as well.”

The investigators acknowledged some limits to the generalizability of the study. Beyond its focus on women, its participants were more than 95% white. In a press release, Mora said the findings could be even more dramatic in ethnic and racial groups that have a higher prevalence of metabolic syndrome, insulin resistance, and diabetes, among other risk factors.

“Diabetes is mostly preventable, but it’s a systems-wide problem, and we urgently need further research into new strategies to address it,” Mora said. “These could be innovative lifestyle-based strategies, like community efforts, greater public health efforts, ways to medically target metabolic pathways, or new surgical approaches.”


Diabetes powerfully associated with premature coronary heart disease in women [news release]. EurekAlert; January 20, 2021. Accessed January 21, 2021.