The cardioprotective effect of female gender is abrogated in the presence of type 2 diabetes, and female diabetic patients thus face comparable cardiovascular risk as men with type 2 diabetes. The SubEndocardial Viability Ratio (SEVR) is an index of myocardial oxygen supply and demand that can be assessed non-invasively by applanation tonometry. We hypothesized that diabetic women would have lower SEVR than diabetic men and non-diabetic subjects independently of conventional risk markers and arterial stiffness.

Methods: 86 patients (mean age 59±10 years, 41 women) with recently diagnosed (median 1.8 years) type 2 diabetes and 86 controls matched individually for gender and age were included. Radial artery pressure waveforms were obtained non-invasively by applanation tonometry. The central aortic waveform was derived using the SphygmoCor transfer function, which enabled calculation of SEVR. Arterial stiffness was assesses by the carotid-femoral pulse wave velocity (PWV).

Results: SEVR was significantly lower in diabetic women compared with i) diabetic men, (161%±26% vs 178%±32%, p<0.01), ii) non-diabetic women (185%±24%) and men (188±28%, p<0.001 for both comparisons). The differences remained significant in a multivariate analysis including age, mean blood pressure, heart rate, smoking, total cholesterol and PWV.

Conclusion: SEVR was significantly lower in diabetic women as compared with both diabetic men and non-diabetic subjects. This association was not mediated by arterial stiffness. Low SEVR may independently contribute to the increased cardiovascular morbidity seen in diabetic women.