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This version published online on March 18, 2008
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2007-2025
A more recent version of this article appeared on June 1, 2008
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Submitted on September 10, 2007
Accepted on March 6, 2008

Reproductive History and Hormonal Birth Control Use are Associated with Coronary Calcium Progression in Women with Type 1 Diabetes Mellitus

Janet K Snell-Bergeon*, Dana Dabelea, Lorraine G Ogden, John E Hokanson, Gregory L Kinney, James Ehrlich, and Marian Rewers

Barbara Davis Center for Childhood Diabetes, University of Colorado at Denver and Health Sciences Center, Denver, CO; Department of Preventive Medicine & Biometrics, University of Colorado at Denver and Health Sciences Center, Denver, CO; Department of Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO; George Washington University Medical Center, Washington D.C.

* To whom correspondence should be addressed. E-mail: Janet.Snell-Bergeon{at}uchsc.edu.

Context: Coronary Artery Disease (CAD) is increased in women with type 1 diabetes (T1D) compared to non-diabetic (Non-DM) women. Women with T1D have more menstrual dysfunction and are less likely to use hormonal birth control (BC) than Non-DM women.

Objective: The purpose of this study was to determine if coronary artery calcium (CAC) is associated with menstrual dysfunction and BC use in women with T1D.

Materials and Methods: This is a prospective cohort study, and participants were followed for an average of 2.4 years.

Patients: 612 women (293 T1D, 319 Non-DM) between the ages of 19 and 55 who had CAC measured twice by Electron Beam Tomography.

Results: Irregular menses and amenorrhea were more common in T1D than Non-DM women (22.1% vs. 14.9%, p<0.05 and 16.6% vs. 7.0%, p<0.001). T1D women reported less BC use than Non-DM women (79.8% vs. 89.9%, p<0.001) and reached menarche at an older age (13.1 ± 1.8 vs. 12.8 ± 1.5 yrs, p<0.05). Use of BC was associated with less CAC progression in all women, but this association was stronger in T1D women (p-value for interaction=0.01). Irregular menses were associated with greater CAC progression only among T1D women.

Conclusions: A prior history of BC use is associated with reduced CAC progression among all women, with a stronger association in T1D than in Non-DM women. Women with T1D who report irregular menses have increased CAC progression compared to those with regular menses.
Key words: Type 1 Diabetes • Coronary Artery Disease • Birth Control






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