Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305).
Background. Research has shown less aggressive treatment and poorer control of cardiovascular disease (CVD) risk factors in women than men. Methods. We analyzed sex differences in pharmacotherapy strategies and attainment of goals for hemoglobin A1c (HbA1c), blood pressure (BP), and low density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes and established coronary artery disease enrolled into the BARI 2D trial. Results. Similar numbers of drugs were prescribed in both women and men. Women were less frequent on metformin or sulfonylurea and more likely to take insulin and to be on higher doses of hydroxymethylglutaryl-CoA reductase inhibitors (statins) than men. After adjusting for baseline differences and treatment prescribed, women were less likely to achieve goals for HbA1c (OR = 0.71, 95% CI 0.57, 0.88) and LDL-C (OR = 0.64, 95% CI 0.53, 0.78). More antihypertensives were prescribed to women, and yet BP ≤ 130/80 mmHg did not differ by sex. Conclusions. Women entering the BARI 2D trial were as aggressively treated with drugs as men. Despite equivalent treatment, women less frequently met targets for HbA1c and LDL-C. Our findings suggest that there may be sex differences in response to drug therapies used to treat diabetes, hypertension, and hyperlipidemia.
Abstract. Commercial data sources have been increasingly used to measure and locate community resources. We describe a methodology for combining and comparing the differences in commercial data of the food and alcohol environment. We used commercial data from two commercial databases (InfoUSA and Dun&Bradstreet) for 2003 and 2009 to obtain information on food and alcohol establishments and developed a matching process using computer algorithms and manual review by applying ArcGIS to geocode addresses, standard industrial classification and North American industry classification taxonomy for type of establishment and establishment name. We constructed population and area-based density measures (e.g. grocery stores) and assessed differences across data sources and used ArcGIS to map the densities. The matching process resulted in 8,705 and 7,078 unique establishments for 2003 and 2009, respectively. There were more establishments captured in the combined dataset than relying on one data source alone, and the additional establishments captured ranged from 1,255 to 2,752 in 2009. The correlations for the density measures between the two data sources was highest for alcohol outlets (r = 0.75 and 0.79 for per capita and area, respectively) and lowest for grocery stores/supermarkets (r = 0.32 for both). This process for applying geographical information systems to combine multiple commercial data sources and develop measures of the food and alcohol environment captured more establishments than relying on one data source alone. This replicable methodology was found to be useful for understanding the food and alcohol environment when local or public data are limited.
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