{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T07:30:12Z","timestamp":1784619012822,"version":"3.55.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"4","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"name":"Rossi Memorial Fund"},{"DOI":"10.13039\/100000041","name":"American Diabetes Association","doi-asserted-by":"publisher","award":["7-23-ICTSWH-19"],"award-info":[{"award-number":["7-23-ICTSWH-19"]}],"id":[{"id":"10.13039\/100000041","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01-DK034818"],"award-info":[{"award-number":["R01-DK034818"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>We examined sex differences in longitudinal blood pressure (BP) and 32-year cardiovascular disease (CVD) incidence in the Pittsburgh Epidemiology of Diabetes Complications type 1 diabetes cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>BP was measured up to nine (median six) times between 1986\u20131988 baseline and 2016\u20132018; n = 300 women and 304 men without CVD at baseline were followed until December 2020 for incidence of total CVD, major adverse cardiovascular events (MACE) (CVD death, myocardial infarction [MI], or stroke), and hard coronary artery disease (hCAD) (CAD death, MI, or coronary revascularization\/blockage \u2265 50%). We estimated associations between time to event and longitudinal systolic BP (SBP) and diastolic BP (DBP) by sex using joint models adjusted for time-varying longitudinal antihypertensive (AH) medication use, HbA1c, and overt nephropathy, baseline age, and other CVD risk factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Longitudinal SBP was 5.8 mmHg lower (P &amp;lt; 0.0001) and DBP 6.2 mmHg lower (P &amp;lt; 0.0001) in women versus men. Women had \u22120.3 mmHg\/year faster DBP decline (P &amp;lt; 0.0001) despite similar AH rates by sex. Incidence of CVD was similar by sex. Each 5-mmHg increment in longitudinal SBP (hazard ratio [HR] = 1.23; 95% CI 1.04, 1.45) and DBP (HR = 1.56; 95% CI 1.20, 2.04) was associated with MACE in men only; DBP (HR = 1.28; 95% CI 1.05, 1.56) was associated with hCAD in women only.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>BP was lower in women than men, and the strength of its association with the initial manifestation of CVD differed by sex. Further research into sex-specific BP mechanisms is needed to improve CVD risk reduction in people living with type 1 diabetes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc24-2258","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T16:38:07Z","timestamp":1739291887000},"page":"605-613","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":2,"title":["Sex-Specific Blood Pressure Trajectories and Cardiovascular Disease in Type 1 Diabetes: 32-Year Follow-up of the Pittsburgh Epidemiology of Diabetes Complications Cohort"],"prefix":"10.2337","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1845-8477","authenticated-orcid":false,"given":"Rachel G.","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor J.","family":"Orchard","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9303-3810","authenticated-orcid":false,"given":"Tina","family":"Costacou","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"2025032118523245800_B1","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S2213-8587(14)70248-7","article-title":"Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis","volume":"3","author":"Huxley","year":"2015","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025032118523245800_B2","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1053\/j.ajkd.2011.05.025","article-title":"Sex differences in the development of kidney disease in individuals with type 1 diabetes mellitus: a contemporary analysis","volume":"58","author":"Costacou","year":"2011","journal-title":"Am J Kidney Dis"},{"key":"2025032118523245800_B3","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.jdiacomp.2018.01.002","article-title":"Sex-specific differences in insulin resistance in type 1 diabetes: the CACTI cohort","volume":"32","author":"Millstein","year":"2018","journal-title":"J Diabetes Complications"},{"key":"2025032118523245800_B4","doi-asserted-by":"crossref","first-page":"e2230710","DOI":"10.1001\/jamanetworkopen.2022.30710","article-title":"Cardiometabolic risk factors and incident cardiovascular disease events in women vs men with type 1 diabetes","volume":"5","author":"Braffett","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2025032118523245800_B5","doi-asserted-by":"crossref","first-page":"117270","DOI":"10.1016\/j.atherosclerosis.2023.117270","article-title":"Sex differences in lipids: a life course approach","volume":"384","author":"Holven","year":"2023","journal-title":"Atherosclerosis"},{"key":"2025032118523245800_B6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1001\/jamacardio.2019.5306","article-title":"Sex differences in blood pressure trajectories over the life course","volume":"5","author":"Ji","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2025032118523245800_B7","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.2337\/dc19-0480","article-title":"Optimal blood pressure thresholds for minimal coronary artery disease risk in type 1 diabetes","volume":"42","author":"Guo","year":"2019","journal-title":"Diabetes Care"},{"key":"2025032118523245800_B8","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.genm.2012.05.003","article-title":"Sex differences in cardiovascular disease risk in adolescents with type 1 diabetes","volume":"9","author":"Krishnan","year":"2012","journal-title":"Gend Med"},{"key":"2025032118523245800_B9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13633-016-0026-6","article-title":"Influences of gender on cardiovascular disease risk factors in adolescents with and without type 1 diabetes","volume":"2016","author":"Brown","year":"2016","journal-title":"Int J Pediatr Endocrinol"},{"key":"2025032118523245800_B10","doi-asserted-by":"crossref","first-page":"330","DOI":"10.2307\/2533118","article-title":"A joint model for survival and longitudinal data measured with error","volume":"53","author":"Wulfsohn","year":"1997","journal-title":"Biometrics"},{"key":"2025032118523245800_B11","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/01621459.1995.10476485","article-title":"Modeling the relationship of survival to longitudinal data measured with error. 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