Research Description
Cardiovascular disease (CVD) is the deadliest complication in type 2 diabetes (T2D) and disproportionately affects women with T2D. Possible explanations for women’s vulnerability to CVD in T2D have been derived from studies focusing on middle-aged women, including the loss of estrogen protection due to menopause. Little is known about the cumulative impact of risk factors (RFs) throughout adolescence and young adulthood. T2D is no longer a middle-aged disease and increasingly affects young people, particularly young women. The candidate’s proposal will clarify whether women with early-onset T2D have a greater cumulative burden of RFs that lead to their higher CVD risk than men in midlife. Clarifying RF changes from a younger age would promote early prevention in women and men with T2D. Doctors and patients hope to adopt an individualized approach to T2D management to reduce cardiovascular complications, but research has not provided enough evidence to support such an approach. We need a more in-depth and precise understanding of which subgroups are at high CVD risk. Since women and men have different CVD risks, high-risk subgroup characterization must consider sex-specific RFs. The candidate will use novel and robust analysis that systemically evaluates lifetime medical histories, laboratory results, and genetic information in women and men with T2D to identify and characterize high-risk subgroups. These findings can be integrated into sex-based clinical guidelines to better guide doctors and patients in the individualized management of T2D and may provide insights into therapeutic developments to prevent CVD or reverse its progression.Research Profile
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?Cardiovascular disease (CVD), including heart disease, stroke, and blood vessel disease, is the leading cause of death in type 2 diabetes (T2D). Women with T2D are significantly more likely to die from CVD than men with T2D. We know little about why women are more susceptible to this deadly complication. T2D increasingly affects young people. Notably, adolescent girls are twice as likely to be diagnosed with T2D as boys. It is possible that women diagnosed with T2D at a young age experience a greater cumulative impact of risk factors, such as high blood sugar, high blood pressure, and lipid dysregulation than men, consequently, more likely to die from CVD. This study will firstly identify which risk factor(s) likely cause more CVD and CVD-associated death in women than men. The findings will inform more targeted risk factor management to prevent CVD from occurring. Patients with T2D have a varying propensity to develop CVD. Even among women with T2D, some are more susceptible to CVD, and some with lower risk due to various factors, such as genetics, pre-existing health conditions, and health behaviors. Classifying subgroups of young patients in each sex group with a high risk of developing CVD could allow doctors to use more intensive monitoring and treatment for high-risk patients. To this end, the second objective of the study is to identify which subgroups of men and women with T2D are at high CVD risk. The findings will be used to guide doctors to apply the right resources to the right patients.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?Given the sex disparity in diabetic CVD, we must consider sex-specific risk factors for high-risk subgroup classification. I will use novel and robust analysis that systemically evaluates lifetime medical histories, laboratory results, and genetic information in women and men with T2D to identify and characterize CVD risk subgroups. These findings can be integrated into sex-based clinical guidelines to navigate doctors and patients in the individualized management of T2D and provide insights into new therapeutic developments to prevent CVD or reverse its progression.
Why important for you, personally, to become involved in diabetes research? What role will this award play?Several of my family members have prediabetes or type 2 diabetes. I am committed to a research career as an independent investigator and leader in precision epidemiology to inform new therapeutics and prevention development for many affected by diabetes, including my family members. My current goal is to improve knowledge of mechanisms underlying the sex disparities in diabetic cardiovascular disease (CVD) by leveraging life-course cohorts through robust and innovative analytical approaches. To foster my independence in this research area, I propose to characterize the role of female sex in the deleterious influence of early-onset type 2 diabetes (T2D) on CVD through the American Diabetes Association (ADA) Women’s Health and Diabetes Junior Faculty Development Award. My research and training experience in chronic disease epidemiology has led me to this career path, and this ADA Award will allow me to make great strides toward my career goal.
In what direction do you see the future of diabetes research going?We need more research to provide a life-course perspective on mechanisms for the poorly understood sex disparity in diabetic CVD and to provide timely information for sex-based strategies to prevent and reverse CVD progression in T2D. The sex-based preventive and therapeutic approaches will likely reduce CVD among men and women with T2D and help them live longer, healthier lives.