Gender differences in cardiovascular disease risk factors, treatments and complications in patients with type 2 diabetes: the RIACE Italian multicentre study

Abstract

Penno G, Solini A,. Gender differences in cardiovascular disease risk factors, treatments and complications in patients with type 2 diabetes: the RIACE Italian multi-centre study. J Intern Med 2013; 274: 176-191. Objectives. Poorer control of risk factors for cardio-vascular disease (CVD) has been reported in diabetic women, as compared with diabetic men. It has been proposed that this finding is due to gender disparities in treatment intensity. We investigated this hypothesis in a large contemporary cohort of subjects with type 2 diabetes. Design. Observational, cross-sectional study. Subjects and setting. Consecutive patients with type 2 diabetes from the Renal Insufficiency And Cardio-vascular Events (RIACE) Italian multicentre study (n = 15 773), attending 19 hospital-based diabetes clinics in 2007-2008. Main outcome measures. Traditional CVD risk factors, macro-and microvascular complications and current glucose-, lipid-and blood pressure (BP)-lowering treatments were assessed. Results. Although CVD was more prevalent in men, women showed a less favourable CVD risk profile and worse performance in achieving treatment targets for haemoglobin A 1c , LDL, HDL and non-HDL cholesterol, systolic blood pressure (BP) and in particular obesity [body mass index (BMI) and waist circumference], but not for triglycerides and diastolic BP. However, women were more frequently receiving pharmacological treatment for hypertension and to a lesser extent hyperglyca-emia and dyslipidaemia than men, and female gender remained an independent predictor of unmet therapeutic targets after adjustment for confounders such as treatments, BMI, duration of diabetes and, except for the systolic BP goal, age. Conclusions. In women with type 2 diabetes from the RIACE cohort, a more adverse CVD risk profile and a higher likelihood of failing treatment targets, compared with men, were not associated with treatment differences. This suggests that factors other than gender disparities in treatment intensity are responsible.

Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events

“…It has long been speculated that there is a widespread sex disparity in the management and treatment of cardiovascular risk factors in individuals with diabetes, to the detriment of women. Historically, women with diabetes were more likely to have a more adverse cardiovascular risk profile and were less likely to achieve the recommended levels of risk factors compared with male counterparts; in particular, this may have affected the sex-specific estimates from the older cohort studies that were established when there were significant disparities in treatment between sexes [19][20][21][22]. Indeed, the results of the present study provide some marginal evidence that the excess risk of diabetes in women was more pronounced in cohorts with baseline data collection before 1985 than in cohorts with baseline data collection after 1985.…”

MECHANISMS IN ENDOCRINOLOGY: Cardiovascular risk in women with type 2 diabetes mellitus and prediabetes: is it indeed higher than men?

“…There are conflicting data about the difference in achieving HbA1c targets (17,50,51,52). In one study, 46.6% of diabetic women failed to achieve the goal for systolic BP vs 41.2% of diabetic men.…”

“…Sex differences in specific situations, such as renal failure (50) and rheumatic disorders such as lupus (63), must also be taken into account. CVD is more prevalent in men with DM and renal failure compared with women, although the latter display a less favourable CVD risk profile and less frequently achieve the treatment targets for HbA1c, lipid and systolic BP (50). Similarly, men with lupus are more likely to suffer from CVD and greater disease activity compared with women with lupus, although data are limited (63).…”

Fatores Associados a Tensão Arterial Não Controlada em Pessoas com Diabetes Tipo 2 Seguidas nos Cuidados de Saúde Primários em Portugal

“…Foram associadas a melhor controlo da hipertensão vá-rias características socio-demográficas dos doentes como o sexo masculino, 16,17 a idade mais jovem [17][18][19] e maior formação. 19,20 Quanto a variáveis associadas a outros fatores de risco, o controlo tensional foi associado a menores ní-veis de colesterol LDL, 18,21 Sabendo quais as características das pessoas com diabetes associadas a pior controlo da tensão arterial, poderemos intervir nesses sub-grupos de forma diferenciada de forma a estrategicamente investir na redução da morbimortalidade associada a esta doença.…”