{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T23:34:33Z","timestamp":1793921673839,"version":"4.8.0"},"reference-count":35,"publisher":"BMJ","issue":"1","funder":[{"name":"the Dutch Ministry of Economic Affairs"},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["849200001"],"award-info":[{"award-number":["849200001"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009709","name":"Stichting De Weijerhorst","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009709","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100016244","name":"Health Foundation Limburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100016244","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Pearl String Initiative Diabetes"},{"name":"Janssen-Cilag B.V."},{"name":"Stichting Annadal"},{"name":"Sanofi-Aventis Netherlands B.V."},{"DOI":"10.13039\/100020979","name":"province of Limburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100020979","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Novo Nordisk Farma B.V."},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2019,10,14]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate whether adverse differences in levels of cardiovascular risk factors in women than men, already established when comparing individuals with and without diabetes, are also present before type 2 diabetes onset.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>In a population-based cohort study of individuals aged 40-75 years (n=3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated associations with cardiometabolic and lifestyle risk factors of (1) pre-diabetes and type 2 diabetes (reference category: normal glucose metabolism) and (2) among non-diabetic individuals, of continuous levels of hemoglobin A1c (HbA1c). Age-adjusted sex differences were analyzed using linear and logistic regression models with sex interaction terms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In pre-diabetes, adverse differences in cardiometabolic risk factors were greater in women than men for systolic blood pressure (difference, 3.02\u2009mm Hg; 95%\u2009CI:\u22120.26 to 6.30), high-density lipoprotein (HDL) cholesterol (difference, \u22120.10\u2009mmol\/L; 95% CI: \u22120.18 to \u22120.02), total-to-HDL cholesterol ratio (difference, 0.22; 95% CI: \u22120.01 to 0.44), triglycerides (ratio: 1.11; 95% CI: 1.01 to 1.22), and inflammation markers Z-score (ratio: 1.18; 95% CI: 0.98 to 1.41). In type 2 diabetes, these sex differences were similar in direction, and of greater magnitude. Additionally, HbA1c among non-diabetic individuals was more strongly associated with several cardiometabolic risk factors in women than men: per one per cent point increase, systolic blood pressure (difference, 3.58\u2009mm Hg; 95% CI: \u22120.03 to 7.19), diastolic blood pressure (difference, 2.10\u2009mm Hg; 95% CI: \u22120.02 to 4.23), HDL cholesterol (difference, \u22120.09\u2009mmol\/L; 95% CI: \u22120.19 to 0.00), and low-density lipoprotein cholesterol (difference, 0.26\u2009mmol\/L; 95% CI: 0.05 to 0.47). With regard to lifestyle risk factors, no consistent pattern was observed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our results are consistent with the concept that the more adverse changes in cardiometabolic risk factors in women (than men) arise as a continuous process before the onset of type 2 diabetes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2019-000787","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T09:45:14Z","timestamp":1573811114000},"page":"e000787","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Adverse differences in cardiometabolic risk factor levels between individuals with pre-diabetes and normal glucose metabolism are more pronounced in women than in men: the Maastricht Study"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2858-1874","authenticated-orcid":false,"given":"Rianneke","family":"de Ritter","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands"},{"name":"CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone J S","family":"Sep","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands"},{"name":"CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands"},{"name":"Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla J H","family":"van der Kallen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands"},{"name":"CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8113-7604","authenticated-orcid":false,"given":"Miranda T","family":"Schram","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands"},{"name":"CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands"},{"name":"Heart and Vascular Centre, Maastricht University Medical Centre+, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie","family":"Koster","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, Maastricht University, Maastricht, The Netherlands"},{"name":"CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham A","family":"Kroon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands"},{"name":"CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2989-1631","authenticated-orcid":false,"given":"Marleen M J","family":"van Greevenbroek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands"},{"name":"CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone J P M","family":"Eussen","sequence":"additional","affiliation":[{"name":"CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands"},{"name":"Department of Epidemiology, Maastricht University, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter C","family":"Dagnelie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands"},{"name":"CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9260-4458","authenticated-orcid":false,"given":"Marit","family":"de Jong","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical 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