Ju, Jinghui
(2024)
The interrelationship between reproductive and cardiometabolic factors among women with childhood-onset type 1 diabetes.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
The findings of this dissertation contribute to a deeper understanding of the intricate relationship between reproductive health and cardiometabolic health in women with type 1 diabetes. The analyses were based on data from a population-based cohort study of individuals with child-onset type 1 diabetes and its ancillary study focusing on the evaluation of the role of high-density lipoprotein (HDL) in coronary artery disease (CAD). Our first objective was to assess the predictive role of reproductive factors on cardiovascular disease in women with type 1 diabetes. The findings indicated that age at menarche and the number of pregnancies influenced the risk of cardiovascular disease among women with type 1 diabetes. Our second objective was to assess potential determinants of HDL structure and function at the study baseline in men and women with type 1 diabetes. The findings revealed distinct factors associated with HDL structure and function in men compared with women. Our third objective was to examine the patterns of HDL particle (HDL-P) concentrations and cholesterol efflux capacity over a 25-year period, as well as the patterns by subsequent CAD status in both men and women with type 1 diabetes. We found that HDL particle concentrations increased while cholesterol efflux capacity decreased over time in both sexes, indicating an aging effect with notable sex-specific differences in the rate of change. Additionally, in male participants, but not in female participants, small HDL-P appeared to increase faster, while cholesterol efflux capacity per HDL particle appeared to decline more rapidly in those who developed CAD compared to those who did not.
This dissertation work holds important public health significance and clinical implications as, upon replication, its findings could potentially form the basis for identifying high cardiovascular risk subgroups in women with type 1 diabetes based on reproductive factors, such as menarche age. The identification of distinct determinants of HDL metrics by sex and distinct patterns of HDL metrics over time by sex and coronary artery disease status may further lead to the development of distinct interventions for men versus women to reduce cardiovascular risk in type 1 diabetes.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
14 May 2024 |
| Date Type: |
Publication |
| Defense Date: |
25 January 2024 |
| Approval Date: |
14 May 2024 |
| Submission Date: |
24 April 2024 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
178 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
type 1 diabetes, reproductive health, cardiovascular disease, high-density lipoprotein |
| Date Deposited: |
14 May 2024 19:02 |
| Last Modified: |
14 May 2024 19:02 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/46163 |
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