Differences in the Cardiometabolic Control in Type 2 Diabetes according to Gender and the Presence of Cardiovascular Disease: Results from the eControl Study

Abstract

The objective of this cross-sectional study was to assess differences in the control and treatment of modifiable cardiovascular risk factors (CVRF: HbA1c, blood pressure [BP], LDL-cholesterol, body mass index, and smoking habit) according to gender and the presence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. The study included available data from electronic medical records for a total of 286,791 patients. After controlling for sex, age, diabetes duration, and treatment received, both men and women with prior CVD had worse cardiometabolic control than patients without previous CVD; women with prior CVD had worse overall control of CVRFs than men except for smoking; and women without prior CVD were only better than men at controlling smoking and BP, with no significant differences in glycemic control. Finally, although the proportion of women treated with lipid-lowering medications was similar to (with prior CVD) or even higher (without CVD) than men, LDL-cholesterol levels were remarkably uncontrolled in both women with and women without CVD. The results stress the need to implement measures to better prevent and treat CVRF in the subgroup of diabetic women, specifically with more intensive statin treatment in those with CVD.

Gender Differences in Risks of Coronary Heart Disease and Stroke in Patients with Type 2 Diabetes Mellitus and Their Association with Metabolic Syndrome in China

“…The results of the present large-scale study showed that the TC and LDL-c levels were higher in women with T2DM than in men with T2DM, a finding consistent with those of previous studies [6, 17]. By studying patients with T2DM from 236 diabetes centers in Italy, Russo et al found that, compared to men, women had higher levels of TC, HDL-c, and LDL-c, were older, and had diabetes for a longer duration; further, more women than men failed to achieve the control goal of LDL-c levels [17].…”

“…By studying patients with T2DM from 236 diabetes centers in Italy, Russo et al found that, compared to men, women had higher levels of TC, HDL-c, and LDL-c, were older, and had diabetes for a longer duration; further, more women than men failed to achieve the control goal of LDL-c levels [17]. Similarly, the eControl Study showed that, in the overall Spanish population, although the proportion of women on lipid-lowering therapy was slightly higher than that of men, the LDL-c levels in women were significantly higher than those in men; thus, irrespective of whether they have CVD as a complication, it is more difficult for women with T2DM to achieve the control goals of BMI and LDL-c level than it is for men [6]. The differences in the TC and LDL-c levels between genders may be related to differences in the pattern of changes of TC and LDL-c levels with age.…”

“…Gender differences are known to exist in CVD risk factor control in various countries and races. Like the eControl Study conducted in Spain [6], Collier et al found that BMI, TC and HDL-c levels, and the proportion of hypertension were all higher in Scottish women with T2DM than in men. Further, although no differences were found in HbA1c levels, the risks of peripheral vascular disease, ischemic heart disease, and stroke were significantly lower in women than in men [18].…”

“…In the general population, women usually have a 10-year delay in the onset of subclinical atherosclerosis [5] and cardiovascular events compared to men. However, some studies in Western countries have demonstrated that women with diabetes seem less likely to achieve therapeutic goals for blood pressure, low-density lipoprotein (LDL) cholesterol (LDL-c), and glycosylated hemoglobin (HbA1c) [6] and even have a higher risk for CHD than diabetic men. Lifestyle factors like smoking and alcohol consumption are also well known to increase the risk of CVD and cerebrovascular disease.…”

Sex/Gender -Based Pharmacology and Statin Utilization Amongst Elderly Patients with Diabetes

“…In a cohort of high-risk veterans, including 23,955 men and 1,010 women, LDL-C values were higher in women than men, with age-adjusted estimated mean values of 111.7 vs. 97.6 mg/dL (p < .01) [35]. A Spanish study, which included available data from electronic medical records for a total of 286,791 patients, reported although the proportion of women treated with lipidlowering medications was similar to (with prior CVD) or even higher (without CVD) than men, LDL-cholesterol levels were remarkably uncontrolled in both women with and women without CVD [36]. A Chinese study explored the reasons for the disparity in the lipid-lowering treatment goal attainment rates between women and men, and concluded that nearly half of the sex/gender disparity in lipid-lowering treatment goal attainment rates can be explained by the sex/gender differences in baseline lipid levels, socioeconomic status, cardiovascular comorbidities and associated risk factors, and the dosage of statin in high and very high CVD risk patients; however, the other half of the sex/gender disparity remains unexplained and requires further study to fully understand what other factors are at play [37].…”