Sex Disparities in the Treatment and Control of Cardiov...

Sex Disparities in the Treatment and Control of Cardiovascular Risk Factors in Type 2 Diabetes

Sex Disparities in the Treatment and Control of Cardiovascular Risk Factors in Type 2 Diabetes
Published online March 28, 2008
Received for publication January 29, 2008. Accepted for publication March 25, 2008.
Ioanna Gouni-Berthold, MD1, Heiner K. Berthold, MD, PHD2, Christos S. Mantzoros, MD3, Michael Böhm, MD4 and Wilhelm Krone, MD1
Diabetes Care
© 2008 by the American Diabetes Association

Ioanna Gouni-Berthold, MD1, Heiner K. Berthold, MD, PHD2, Christos S. Mantzoros, MD3, Michael Böhm, MD4 and Wilhelm Krone, MD1

1 Department of Internal Medicine II, University of Cologne, Cologne, Germany
2 University of Bonn, Department of Clinical Pharmacology, Bonn, Germany
3 Department of Medicine, Harvard Medical School, Boston, Massachusetts
4 Department of Internal Medicine III, University of Homburg/Saar, Homburg/Saar, Germany

Corresponding author: Ioanna Gouni-Berthold, ioanna.berthold@uni-koeln.de

ABSTRACT

OBJECTIVE—To assess whether sex differences exist in the effective control and medication treatment intensity of cardiovascular disease (CVD) risk factors.

RESEARCH DESIGN AND METHODS—We performed a cross-sectional analysis including 44,893 patients with type 2 diabetes (51% women). End points included uncontrolled CVD risk factors (LDL cholesterol ≥130 mg/dl, systolic blood pressure [SBP] ≥140 mmHg, and A1C ≥8%) and the intensity of medical management in patients with uncontrolled CVD risk factors. Multiple-adjusted odds ratios were calculated after stratification for the presence of CVD (present in 39% of the patients).

RESULTS—Women with CVD were less likely to have SBP, LDL cholesterol, and A1C controlled and less likely to receive intensive lipid-lowering treatment. Women without CVD were less likely than men to have LDL cholesterol controlled with no differences in SBP or A1C control.

CONCLUSIONS—Women with diabetes and CVD have poorer control of important modifiable risk factors than men and receive less intensified lipid-lowering treatment.

INTRODUCTION

Mortality rates from cardiovascular disease (CVD) have been declining during recent years in both men and women in the U.S. and Europe (1,2). However, in patients with diabetes, a decrease has been observed only in men (2). Furthermore, the relative risk for fatal diabetes-associated coronary heart disease is 50% higher in women than in men (3). More adverse cardiovascular risk profiles among women with diabetes has been postulated as a possible explanation, as well as potential disparities in treatment that favor men (3–5). A study from U.S. managed care health plans found poorer control of blood pressure and LDL cholesterol in female compared with male patients and suggested that these findings may contribute to the sex disparity in CVD mortality trends (6). No study in Europe has investigated sex disparities in the main cardiovascular risk factors in patients

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