Type 2 diabetes is a chronic condition affecting millions worldwide, but recent research highlights a particularly alarming concern for women: a significantly higher risk of undetected heart damage compared to men. A groundbreaking study conducted by researchers at the University of Leicester has shed light on this issue, revealing critical sex-specific differences in cardiovascular risks among those with type 2 diabetes. This blog post explores the study’s findings, their implications, and actionable steps women can take to protect their heart health.
Understanding the Study: Coronary Microvascular Dysfunction (CMD) in Women
The Leicester study, published in the Journal of Cardiovascular Magnetic Resonance in July 2025, is one of the most comprehensive investigations into coronary microvascular dysfunction (CMD)—a type of early, silent heart damage caused by impaired blood flow in the heart’s smallest vessels. CMD often goes undetected because it doesn’t present with typical symptoms like chest pain or shortness of breath, making it a hidden threat.
Using advanced MRI scans, the researchers analyzed data from four studies conducted at the NIHR Leicester Biomedical Research Centre (BRC). Their findings were striking:
- 46% of women with type 2 diabetes showed signs of CMD, compared to only 26% of men.
- All participants were asymptomatic, meaning they had no diagnosed heart problems or symptoms like chest pain or shortness of breath, yet the scans revealed significant heart damage.
- The drivers of CMD differed by sex: in women, higher body weight (BMI) was the most significant factor, while in men, elevated blood pressure played a larger role.
As lead investigator Professor Gerry McCann noted, “We’re seeing early warning signs of heart disease that aren’t picked up through routine checks, and it’s women who seem to be most affected.” This underscores the need for targeted screening and prevention strategies tailored to women with type 2 diabetes.
Why Are Women at Higher Risk?
The study highlights several reasons why women with type 2 diabetes face a disproportionate risk of heart damage:
- Biological and Hormonal Factors: Women with diabetes often experience a loss of the protective effects of estrogen, particularly as they approach menopause. Estrogen typically supports insulin sensitivity and healthy blood vessel function, but its decline can exacerbate insulin resistance and vascular damage, increasing cardiovascular risk.
- Higher BMI as a Risk Factor: The study found a strong link between higher body weight and CMD in women. Obesity is a known risk factor for type 2 diabetes and can contribute to inflammation and oxidative stress, which damage the heart’s microvessels.
- Underdiagnosis and Undertreatment: Women are less likely to receive aggressive treatment for cardiovascular risk factors compared to men. This disparity, combined with lower therapy adherence in women, can amplify heart disease risks.
- Pre-Diabetes and Gestational Diabetes: Women with a history of gestational diabetes mellitus (GDM) face a two-fold higher risk of cardiovascular disease compared to the general population. Additionally, women tend to have pre-diabetes for longer (about 10 years on average) before progressing to overt diabetes, allowing more time for silent cardiovascular damage to develop.
Broader Context: Type 2 Diabetes and Cardiovascular Disease
Type 2 diabetes significantly increases the risk of cardiovascular disease (CVD), including heart attack, stroke, heart failure, and coronary artery disease. According to a 2014 meta-analysis, diabetes increases the risk of coronary heart disease by approximately two-fold in men and three-fold in women. The Leicester study builds on this by showing that even in the absence of overt symptoms, women with type 2 diabetes are nearly twice as likely as men to have early heart damage.
Moreover, cardiovascular disease remains the leading cause of death in people with diabetes, accounting for about 50.3% of all deaths in type 2 diabetes patients, as reported in a 2018 systematic review. Women with diabetes face a higher relative risk of CVD mortality compared to men, despite men having a higher absolute risk.
Implications for Prevention and Treatment
The Leicester study’s findings have significant implications for how we approach cardiovascular risk in women with type 2 diabetes. Here are key takeaways:
- Sex-Specific Risk Assessment: The differing drivers of CMD—higher BMI in women and elevated blood pressure in men—suggest that cardiovascular risk assessments should be tailored by sex. Women may benefit more from interventions targeting weight management, while men may need a stronger focus on blood pressure control.
- Early Screening: Since CMD is asymptomatic, routine advanced imaging like MRI scans could help detect early heart damage in women with type 2 diabetes, particularly those with risk factors like high BMI or a history of gestational diabetes.
- Lifestyle Interventions: Weight loss through a healthy diet and regular physical activity is critical for women. The study suggests that even modest weight reduction could reduce the risk of CMD and prevent progression to heart failure, a condition especially common in people with type 2 diabetes.
- Aggressive Risk Factor Management: Controlling blood sugar, cholesterol, and blood pressure is essential. Women with diabetes should work closely with healthcare providers to ensure optimal management of these risk factors, as undertreatment is a known issue.
- Newer Medications: Recent trials, such as the LEADER and SUSTAIN-6 trials, have shown that newer glucose-lowering drugs like GLP-1 receptor agonists (e.g., liraglutide, semaglutide) can reduce cardiovascular events in people with type 2 diabetes. These medications may offer additional benefits for women, though more research is needed to explore sex-specific responses.
What Women Can Do to Protect Their Heart Health
If you’re a woman with type 2 diabetes, here are practical steps to reduce your cardiovascular risk:
Monitor Your Health Regularly: Schedule regular check-ups with your healthcare provider to monitor blood sugar, blood pressure, cholesterol, and BMI. Ask about advanced screening options if you have risk factors like obesity or a history of gestational diabetes.
Adopt a Heart-Healthy Lifestyle:
Diet: Focus on a balanced diet rich in vegetables, whole grains, lean proteins, and healthy fats. Limit sugar-sweetened beverages, which are linked to a higher risk of type 2 diabetes and cardiovascular disease.
Exercise: Aim for at least 150 minutes of moderate physical activity per week, such as brisk walking or swimming, to improve insulin sensitivity and support weight loss.
Weight Management: Even a 5-10% reduction in body weight can significantly lower cardiovascular risk.
Quit Smoking: Smoking exacerbates cardiovascular risk in diabetes. If you smoke, seek support for a structured cessation program.
Stay Informed: Understand your personal risk factors, including family history and any history of gestational diabetes. Discuss these with your doctor to create a tailored prevention plan.
Advocate for Yourself: Women are often undertreated for cardiovascular risk factors. Be proactive in discussing your heart health with your healthcare provider and ensure you’re receiving appropriate care.
The Bigger Picture: A Call for Awareness and Action
The Leicester study is a wake-up call for healthcare providers, policymakers, and women with type 2 diabetes. It highlights the need for greater awareness of the unique cardiovascular risks women face and the importance of early detection and intervention. The collaboration between the Cardiovascular, Lifestyle, and Diabetes research teams at the NIHR Leicester BRC demonstrates the power of interdisciplinary efforts in uncovering insights that can improve patient outcomes.
As Dr. Gaurav Gulsin, co-author of the study, emphasized, “This suggests we may need to rethink how we assess cardiovascular risk and that women and men could warrant sex-specific treatments.” By addressing these disparities and tailoring care, we can reduce the burden of heart disease in women with type 2 diabetes.
Conclusion
Women with type 2 diabetes face a hidden but significant risk of heart damage, particularly from coronary microvascular dysfunction. The Leicester study underscores the importance of early screening, sex-specific risk assessment, and proactive lifestyle changes to mitigate this risk. By staying informed, working closely with healthcare providers, and adopting heart-healthy habits, women can take control of their cardiovascular health and reduce the likelihood of serious complications.
For more information on managing diabetes and heart health, visit trusted resources like the American Heart Association or consult your healthcare provider. Stay proactive, stay healthy, and let’s work together to close the gap in cardiovascular care for women.