Physicians' Academy for Cardiovascular Education

Diabetes and insulin resistance associated with highest relative risk for premature CHD in women

Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women

Literature - Dugani SB, Moorthy MV, Li C et al., - JAMA Cardiol. 2021 Jan 20;e207073. doi: 10.1001/jamacardio.2020.7073.

Introduction and methods

Identifying individuals at increased risk of premature coronary heart disease (CHD) is important to reduce premature morbidity and mortality rates. Premature CHD is generally defined as CHD occurring in women before age 65 years and in men before age 55 years [1-3]. This study evaluated the associations of more than 50 clinical risk factors and biomarkers with incident CHD in women.

The study was conducted among 28024 US female health professionals participating in the Women’s Health Study [4-7]. All participants were women (aged ≥45 years) without known CVD at baseline. Baseline risk factors were determined and blood samples for biomarker measurements (including lipid, lipoprotein, inflammatory and metabolic biomarkers) were obtained at baseline (April 30, 1993, to January 24, 1996). Median follow-up was 21.4 years and analyses were conducted from October 1, 2017, to October 1, 2020. The primary outcome was incident CHD, defined as the composite of first MI, PCI, CABG, or CHD death. CHD incidence rates were determined in 4 age groups:<55, 55 to <65, 65 to <75, and ≥75 years. Adjusted hazard ratios (aHRs) were estimated for incident CHD per SD increment of each biomarker and for clinical risk factors.

Main results


This study identified diabetes and insulin resistance as major determinants of premature CHD in women. Other clinical factors associated with premature CHD in women include metabolic syndrome, hypertension, obesity, and smoking.


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Find this article online at JAMA Cardiology

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