OBJECTIVE: Early menopause may be associated with higher cardiovascular disease (CVD) risk. Type 2 diabetes mellitus (T2DM), coupled with early menopause, may result in even greater CVD risk in women. We examined CVD risk in women with early compared with normal-age menopause, with and without T2DM overall, and by race/ethnicity. RESEARCH DESIGN AND METHODS: We pooled data from the Atherosclerosis Risk in Communities study, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. We included women with data on menopausal status, menopausal age, and T2DM, excluding pre- or perimenopausal women and those with prevalent CVD. Outcomes included incident coronary heart disease (CHD), stroke, heart failure (HF), and atherosclerotic cardiovascular disease (ASCVD) (CHD or stroke). We estimated the risk associated with early (<45 years) compared with normal-age menopause using Cox proportional hazards models. Covariates included age, race/ethnicity, education, BMI, blood pressure, cholesterol, smoking, alcohol consumption, antihypertensive medication, lipid-lowering medication, hormone therapy use, and pregnancy history. RESULTS: We included 9,374 postmenopausal women for a median follow-up of 15 years. We observed 1,068 CHD, 659 stroke, 1,412 HF, and 1,567 ASCVD events. T2DM significantly modified the effect of early menopause on CVD risk. Adjusted hazard ratios for early menopause and the outcomes were greater in women with T2DM versus those without (CHD 1.15 [95% CI 1.00, 1.33] vs. 1.09 [1.03, 1.15]; stroke 1.21 [1.04, 1.40] vs. 1.10 [1.04, 1.16]; ASCVD 1.29 [1.09, 1.51] vs. 1.10 [1.04, 1.17]; HF 1.18 [1.00, 1.39] vs. 1.09 [1.03, 1.16]). The modifying effect of T2DM on the association between early menopause and ASCVD was only statistically significant in Black compared with White women. CONCLUSIONS: Early menopause was associated with an increased risk for CVD in postmenopausal women. T2DM may further augment the risk, particularly in Black women.

The mechanism underlying women's higher risk of cardiovascular disease (CVD) associated with diabetes is not fully elucidated but may be related to greater metabolic risk deterioration before diabetes in women than men.¹ The sex disparity in diabetic CVD varies by race. Non-Hispanic Black (Black) women with diabetes have a higher prevalence of CHD and stroke than Black men, while in non-Hispanic White (White) individuals, there is a male predominance in diabetic CVD.² In this study, we investigated whether the increase in metabolic syndrome severity, a continuous biomarker of the severity of metabolic derangement, during prediabetes is more pronounced in women than in men and whether the sex difference varies by race.

Women with type 2 diabetes (T2D) face up to 50% higher risk of cardiovascular disease (CVD) than men. This study evaluated the extent to which pre-diabetes (pre-DM) and undiagnosed T2D is associated with a greater excess risk of CVD in women versus men. Data were pooled from 18,745 CVD-free individuals from the Atherosclerosis Risk in Communities Study, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. The risk of coronary heart disease (CHD), ischemic stroke, and atherosclerotic cardiovascular disease (ASCVD; CHD or stroke) associated with pre-DM or undiagnosed T2D was estimated using Cox models adjusting for sociodemographic factors, concomitant risk factors, medication use, and menopausal status. Data was collected in 2022, and the analysis was performed in 2023. During a median follow-up of 18.6 years, the associations between pre-DM and risk of ASCVD were only significant in women (hazard ratio 1.18, 95%CI 1.01-1.34, P=0.03) but not in men (1.08, 95%CI 1.00-1.28, P=0.06) (p-interaction=0.18). The associations between undiagnosed T2D and CVD outcomes were significant in both sexes, but the effect was more pronounced in women (CHD 1.83, 1.4-2.41, P<.0001 in women vs. 1.6, 1.38-2.07, P=0.007 in men; Stroke 1.99, 1.39-2.72, P<.0001 vs. 1.81, 1.36-2.6, P<.0001; ASCVD 1.86, 1.5-2.28, P<.0001 vs. 1.65, 1.4-1.98, P<.0001) (all p-interactions ≤0.2). Both White and Black patients exhibit similar sex differences. Pre-DM or undiagnosed T2D was associated with a greater excess risk of CVD in women than in men. The sex differential in CVD risk among those without the T2D diagnosis suggests the need for sex-specific guidelines in T2D screening and treatment.

Objective: We evaluated the extent to which studies that tested short message service (SMS)– and application (app)-based interventions for diabetes self-management education and support (DSMES) report on factors that inform both internal and external validity as measured by the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework. Materials and Methods: We systematically searched PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and IEEE Xplore Digital Library for articles from January 1, 2009, to February 28, 2019. We carried out a multistage screening process followed by email communications with study authors for missing or discrepant information. Two independent coders coded eligible articles using a 23-item validated data extraction tool based on the RE-AIM framework. Results: Twenty studies (21 articles) were included in the analysis. The comprehensiveness of reporting on the RE-AIM criteria across the SMS- and app-based DSMES studies was low. With respect to internal validity, most interventions were well described and primary clinical or behavioral outcomes were measured and reported. However, gaps exist in areas of attrition, measures of potential negative outcomes, the extent to which the protocol was delivered as intended, and description on delivery agents. Likewise, we found limited information on external validity indicators across adoption, implementation, and maintenance domains. Conclusions: Reporting gaps were found in internal validity but more so in external validity in the current SMS- and app-based DSMES literature. Because most studies in this review were efficacy studies, the generalizability of these interventions cannot be determined. Future research should adopt the RE-AIM dimensions to improve the quality of reporting and enhance the likelihood of translating research to practice.