Sex differences in the risk of arterial stiffness among adults with different glycemic status and modifications by age

BACKGROUND: Studies indicate lower, comparable, and higher cardiovascular risks in women vs men in normal glucose regulation (NGR), prediabetes, and diabetes, respectively. However, this sex difference is uncertain and aging might play a part. We aimed to estimate sex differences in arterial stiffness in NGR, prediabetes, or diabetes and the potential modifications by age. METHODS: We used baseline data of 9618 participants aged ≥40 years in a large community‐based cohort study in Shanghai. Glycemic status was determined by history of diabetes, fasting and 2‐h post‐load glucose levels, and hemoglobin A1c levels. Arterial stiffness was examined by brachial‐ankle pulse wave velocity (ba‐PWV). Multivariable linear regression analysis was conducted to examine the associations between sex and ba‐PWV levels in glycemic and age categories. RESULTS: Before adjustment for age, women had lower, comparable, and higher ba‐PWV vs men in the NGR, prediabetes, and diabetes groups, respectively. In participants aged 40–59 years, women were associated with lower ba‐PWV levels in generally all glycemic strata after adjustment for age and other confounders. In participants aged ≥60 years, women were associated with significantly higher ba‐PWV levels (β coefficient = 71.5; 95% confidence interval = 23.4, 119.7) and the sex difference was attenuated in the groups of prediabetes and diabetes with a borderline significant interaction between sex and glycemic status (p for interaction = .068). CONCLUSIONS: The sex difference in cardiovascular risks in adults with NGR, prediabetes, or diabetes was dependent on age. Our findings provide new evidence for prioritizing preventive treatment against atherosclerosis in men vs women with different glycemic status.