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• Estrogens and other uncovered associations with diabetes and cardiovascular diseases among female workers
  Jiamei Wang, Fei Peng, Zonggui Wu and Chun Liang
  Published on: 9 October 2018

• Published on: 9 October 2018

  Estrogens and other uncovered associations with diabetes and cardiovascular diseases among female workers

  • Jiamei Wang, Head Nurse Department of Cardiology, Shanghai Changzheng Hospital, Second Military Medical University
  • Other Contributors:
    • Fei Peng, Head Nurse
    • Zonggui Wu, Cardiologist
    • Chun Liang, Cardiologist

  To the Editor

  We read with great interest the article by Gilbert-Ouimet M et al1 recently published in your journal. Such study showed an interesting result that only increased risk of incidence of diabetes occurring among female workers working 45 hours or more per week, and suggested that modification of such risk factors would be helpful to improve prevention strategies and orient policymaking by following up 7065 workers over a 12-year period in Ontario, Canada.
  However, we have some concerns. Firstly, in order to find out the potential relationship between long work hours and the incidence of diabetes, several other independent variables were considered in the analysis process such as sociodemographic and health-related covariates, but the information of menopause and menopausal hormone therapy (MHT) among women was not added. Strong association with increased risk of cardiovascular diseases had been confirmed in several studies and data from large randomized-controlled trials have shown that the decrease of incidence of T2D in women could be achieved by MHT with conjugated estrogens 2,3 . Although the clinical evidence still not be sufficient to recommend the use of hormones for prevention of diabetes among women especially with early menopause or premature ovarian insufficiency4, such detail might be helpful to uncover the neglected association between menopause and increased risk of diabetes.
  Secondly, compared with the increased risk...

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  To the Editor

  We read with great interest the article by Gilbert-Ouimet M et al1 recently published in your journal. Such study showed an interesting result that only increased risk of incidence of diabetes occurring among female workers working 45 hours or more per week, and suggested that modification of such risk factors would be helpful to improve prevention strategies and orient policymaking by following up 7065 workers over a 12-year period in Ontario, Canada.
  However, we have some concerns. Firstly, in order to find out the potential relationship between long work hours and the incidence of diabetes, several other independent variables were considered in the analysis process such as sociodemographic and health-related covariates, but the information of menopause and menopausal hormone therapy (MHT) among women was not added. Strong association with increased risk of cardiovascular diseases had been confirmed in several studies and data from large randomized-controlled trials have shown that the decrease of incidence of T2D in women could be achieved by MHT with conjugated estrogens 2,3 . Although the clinical evidence still not be sufficient to recommend the use of hormones for prevention of diabetes among women especially with early menopause or premature ovarian insufficiency4, such detail might be helpful to uncover the neglected association between menopause and increased risk of diabetes.
  Secondly, compared with the increased risk of incidence of diabetes within women, such risk tended to decrease as the number of work hours increased, which was very interesting. A recent meta-analysis of individual data from 68 prospective studies showed that diabetes increased the risk for occlusive vascular mortality nearly three times among women, so could Gilbert-Ouimet M et al's data be translated into the potential relationship of increased risk of occlusive vascular mortality with more work hours? It would deserve in-depth exploration of the raw data of the Ontario study.
  In conclusion, we appreciate Gilbert-Ouimet M et al for their study in sex difference of work hours and incidence of diabetes. It indeed expanded our knowledge of effects of working long hours on diabetes, but further studies are still needed to investigate the potential effects of menopause and MHT on the association between work hour and increased risk of incidence of diabetes and cardiovascular events among women.

  REFERENCES:

  1. Gilbert-Ouimet M, Ma H, Glazier R, et al. Adverse effect of long work hours on incident diabetes in 7065 Ontario workers followed for 12 years. BMJ Open Diab Res Care 2018; 6: e000496.

  2. Kanaya AM, Herrington D, Vittinghoff E, et al. Glycemic effects of postmenopausal hormone therapy: the Heart and Estrogen/progestin Replacement Study. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003; 138: 1-9.

  3. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA, 2013; 310: 1353-68.

  4. Mauvais-Jarvis F, Manson JE, Stevenson JC, et al. Menopausal Hormone Therapy and Type 2 Diabetes Prevention: Evidence, Mechanisms, and Clinical Implications. Endocr Rev. 2017; 38: 173-88.

  5. Norhammar A. Diabetes and cardiovascular mortality: the impact of sex. Lancet Diabetes Endocrinol. 2018; 6: 517-519.

  ACKNOWLEDGEMENT:

  This work was supported by Program of Shanghai Academic Research Leader (17XD1405000), Program for Outstanding Medical Academic Leader (LJRC2015-21), NSFC grants (91539118, 81611130092) to C.L., NSFC grants (81473445,2014ZX09301307-016) to Z.W.

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  Conflict of Interest:
  None declared.

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