Dyslipidemia and ischemic heart disease mortality among men and women with diabetes.

Goldschmid, Merilyn G.; Barrett‐Connor, Elizabeth; Edelstein, Sharon L.; Wingard, Deborah L.; Cohn, Barbara A.; Herman, William H.

doi:10.1161/01.cir.89.3.991

Cited by 105 publications

(35 citation statements)

References 30 publications

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“…Because it has been reported that the use of a more detailed lipidquality measure reduces the number of patients who appear to be receiving "suboptimal" care (16), we evaluated medication management of LDL cholesterol among the patients whose values were not in control. This measure gives credit for greater effort to manage this CVD risk factor and may reduce the effect of possible biological differences on quality assessment, such as diabetes having a greater adverse effect on lipids in women than in men (5). Nevertheless, we observed an ϳ9% difference between men and women in the estimated probability of being treated with lipidlowering medications.…”

Section: Sex Disparities In Treatment Of Cvd Risk Factorsmentioning

confidence: 78%

Sex Disparities in Control and Treatment of Modifiable Cardiovascular Disease Risk Factors Among Patients With Diabetes

et al. 2008

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OBJECTIVE -Cardiovascular disease (CVD) mortality has decreased in men but not in women with diabetes. We investigated whether sex differences in control and treatment of CVD risk factors might underlie this disparity.RESEARCH DESIGN AND METHODS -We performed cross-sectional analyses from a cohort of patients with diabetes sampled from 10 U.S. managed care health plans. Study end points included not being in control for CVD risk factors (Ն140 mmHg for systolic blood pressure [SBP], Ն3.35 mmol/l for LDL cholesterol, and Ն8.0% for A1C) and the intensity of medication management (number of medication classes) for patients not in control. Logistic regression models with random intercepts were used to adjust probabilities of control and management for demographics, clinical characteristics, and clustering within health plans.RESULTS -There were 1,315 women and 1,575 men with a history of CVD and 3,415 women and 2,516 men without a history of CVD. Among patients with CVD, adjusted estimated probabilities for not being in control and risk differences varied significantly between men and women for SBP (men 41.2%, women 46.6%; risk difference Ϫ5.4% [95% CI Ϫ9.5 to Ϫ1.3]) and LDL cholesterol (men 22.4%, women 28.3%; risk difference Ϫ5.9% [Ϫ9.9 to Ϫ1.8]). There were no significant sex differences in intensity of medication management for patients not in control. In patients without CVD there were no significant differences in control or intensity of medication management.CONCLUSIONS -In diabetic patients with CVD, poorer control of SBP and LDL cholesterol for women may contribute to the sex disparity in CVD mortality trends. Diabetes Care 31:69-74, 2008

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Section: Sex Disparities In Treatment Of Cvd Risk Factorsmentioning

confidence: 78%

Sex Disparities in Control and Treatment of Modifiable Cardiovascular Disease Risk Factors Among Patients With Diabetes

et al. 2008

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“…Among women, a decrease in IHDrelated mortality has been observed only for those without diabetes (3). This difference may be attributable to biological (4) and behavioral factors (5) or possibly differences in the quality of health care received (3). We investigated whether there were differences between men and women regarding the quality of health care related to IHD prevention in a population-based cohort of patients with diabetes, aged 20 -80 years and sampled from 10 managed care health plans and 68 provider groups in the U.S. (6).…”

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confidence: 99%

Sex Differences in Quality of Health Care Related to Ischemic Heart Disease Prevention in Patients With Diabetes

et al. 2004

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Diabetes is a greater risk factor for ischemic heart disease (IHD) in women than in men (1,2). In the U.S., IHD-related mortality has declined among men with and without diabetes (3). Among women, a decrease in IHDrelated mortality has been observed only for those without diabetes (3). This difference may be attributable to biological (4) and behavioral factors (5) or possibly differences in the quality of health care received (3). We investigated whether there were differences between men and women regarding the quality of health care related to IHD prevention in a population-based cohort of patients with diabetes, aged 20 -80 years and sampled from 10 managed care health plans and 68 provider groups in the U.S. (6). RESEARCH DESIGN ANDMETHODS -Participants were surveyed using a standardized computerassisted telephone interview or selfadministered written instrument. Of contacted eligible people, 91% responded to the survey. We examined data from the participants for whom medical records were available to document diabetes care. Interrater reliability () for the main quality measures derived from medical record data ranged from 0.85 to 0.92. The quality of diabetes care related to IHD prevention received by patients during a 12-month period was measured by the frequency of selected process of care measurements: 1) current use of aspirin, lipid-lowering medications, and antihypertensive medications (documented by review of the medical records); 2) received recommendation to take aspirin to lower cardiovascular disease (CVD) risk (among those not using aspirin; ascertained by self-report); and 3) received lipid profile testing (among those not using lipid-lowering medications), urine microalbumin/protein testing (among those not using antihypertensive medications), and HbA 1c testing (documented by medical record review). History of CVD was defined according to selfreported myocardial infarction, stroke, coronary artery bypass, or angioplasty. Hierarchical logistic regression models with random intercepts for health plan, to account for the multilevel study design (health plan, provider group, and patient levels), were used to estimate the predicted probability of receiving each process of care measure after adjusting for the proportion of men in the health plans. We then calculated the risk difference (and 95% CI) between men and women regarding these predicted probabilities.RESULTS -There were 1,302 women and 1,564 men with a CVD history and 3,385 women and 2,506 men without a CVD history. Because women had a history of CVD (27.8%) less often than men (38.4%), analyses were stratified by CVD history. Among patients with a CVD history and patients without a CVD history, as compared with men, women were more likely to be aged Ͼ65 years (55.5 vs. 51.6% and 36.5 vs. 31.1%, respectively), to be from U.S. minority racial/ethnic groups (56.6 vs. 50.9% and 61.9 vs. 57.7%), to report less than high school education (33.4 vs. 25.0% and 24.4 vs. 17.6%), to have a diabetes duration Ն10 years (59.9 vs. 52.2% and 44.8 vs. 38...

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“…The frozen aortas and erythrocytes were homogenized in 0.2 N ZnSO 4 containing 0.05 mmol a-methyl-d-mannoside as an internal standard. The solution mixture was heated at 50°C for 10 min and deproteinization was completed by the addition of 0.2 N Ba(OH) 2 . After centrifugation at 1000´g for 10 min at 4°C, the supernatant was evaporated and dried to a residue, which was silylcated with 0.1 ml of N-trimethylsilylimidazol (GL-Sciences, Tokyo, Japan) at 37°C for 1 h. The trimetylsilyc ethers formed were then assayed with gas chromatograph (GC-17 A, Shimazu Co., Kyoto, Japan).…”

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

An aldose redutase inhibitor prevents the intimal thickening in coronary arteries of galactose-fed beagle dogs

et al. 1999

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Macrovascular complications such as myocardial infarction, angina pectoris and cerebrovascular accidents are the major causes of mortality in diabetic patients [1,2]. Although the maintenance of a good glycaemic control for a long period can decrease the risk of the development of diabetic microangiopathy [3], the development of diabetic macroangiopathy cannot be prevented by glycaemic control [3,4]. Therefore, it is very important to establish the pathogenesis of diabetic macroangiopathy.Various hypotheses including increased polyol pathway activity, protein kinase C (PKC) activation, increased oxidative stress and enhanced non-enzymatic glycation have been implicated in the pathogenesis of diabetic microangiopathy such as retinopathy, nephropathy and neuropathy [5,6]. Hyperglycaemia-induced metabolic alterations could also contribute to the development of diabetic macroangiopathy. Although the importance of the latter three metabolic deficits in the pathogenesis of diabetic macroangiopathy have been investigated precisely [7±12], the relation between polyol pathway hyperactivity and diabetic macroangiopathy remains unclear. Diabetologia (1999) Abstract Aims/hypothesis. Although increased polyol pathway activity has been implicated in the pathogenesis of diabetic microangiopathy, the relation with diabetic macroangiopathy remains unclear. Galactose feeding is known to stimulate the polyol pathway and to develop abnormalites similar to those in diabetic microangiopathy. Our study was conducted to investigate whether an activation of polyol pathway by long-term treatment with galactose produced morphological changes in coronary arteries of dogs and the effect of an aldose reductase inhibitor, epalrestat, was also studied. Methods. Dogs received either normal chow or chow containing 30 % galactose with or without epalrestat given orally (20 or 50 mg × kg ±1 ). After 44 months, morphometric analyses of coronary arteries were carried out and the galactitol contents in aortas were measured.Results. The ratio of areas of the intimal layer to those of the medial layer, an indicator of intimal thickening, was statistically significantly increased in galactosefed dogs compared with control dogs. Galactose-fed dogs had a remarkable accumulation of galactitol in their aortas. These morphological and biochemical deficits were reduced by treatment with epalrestat. Conclusion/interpretation. This report morphologically shows diabetes-like macrovascular abnormalities in galactosaemic animals, suggesting that polyol pathway hyperactivity is closely related to the development of diabetic macroangiopathy, which could be prevented by aldose reductase inhibition. [Diabetologia (1999

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Dyslipidemia and ischemic heart disease mortality among men and women with diabetes.

Cited by 105 publications

References 30 publications

Sex Disparities in Control and Treatment of Modifiable Cardiovascular Disease Risk Factors Among Patients With Diabetes

Sex Disparities in Control and Treatment of Modifiable Cardiovascular Disease Risk Factors Among Patients With Diabetes

Sex Differences in Quality of Health Care Related to Ischemic Heart Disease Prevention in Patients With Diabetes

An aldose redutase inhibitor prevents the intimal thickening in coronary arteries of galactose-fed beagle dogs

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