Gender Differences in the Control of Cardiovascular Risk Factors in Patients with Type 2 Diabetes -A Cross-Sectional Study

Abstract

Objective Trends in diabetes and cardiovascular mortality rates are considerably different between women and men; this can be partially explained by differences in diabetes control. The aim of this cross-sectional study was to assess whether sex differences exist in effective control of cardiovascular risk factors among persons with type 2 diabetes treated at the Vuk Vrhovac University Clinic in 2008. Materials and MethodsWe performed a cross-sectional analysis including 8,775 patients who attended the clinic in 2008. Levels of HbA1c, systolic and diastolic blood pressure (SBP, DBP), LDL-cholesterol (LDL) and triglycerides (TG) were analyzed. Multiple adjusted odds-ratios were calculated for categories of cardiovascular risk factors considered not being in control (HbA1c "7%, SBP "130 mmHg, DBP "80 mmHg, LDL "2.5 mmol/L, TG "1.7 mmol/L). Results Women had higher levels of HbA1c (7.05 vs. 6.86%; p<0.001), despite the fact that a larger proportion of women were receiving insulin therapy than men (51.3% vs. 44%). Women also had higher mean values of SBP (144.7 vs. 141.9 mmHg; p<0.001) and LDL (2.92 vs. 2.84 mmol/L). There were no differences in DBP (86.1 vs. 86.0 mmHg; p=0.748) and only triglyceride levels were higher in men (2.04 vs. 1.94 mmol/L; p=0.003). In multi-adjusted logistic regression model female sex was associated with a higher odds ratio of having uncontrolled values of HbA1c (OR=1.21; 95%CI 1.11-1.32), SBP (OR=1.21; 95%CI 1.07-1.37) and LDL (OR=1.13; 95%CI 1.04-1.23). Conclusion Women with diabetes have poorer control of main potentially modifiable cardiovascular risk factors than men. This could contribute to disparities in trends in cardiovascular mortality and it demands clinicians' and public health awareness.

Personal attributes that influence the adequate management of hypertension and dyslipidemia in patients with type 2 diabetes. Results from the DIAB-CORE Cooperation

“…However, a number of recent studies that focused on gender differences [25-30] found that female patients with diabetes had a worse cardiovascular risk profile and were less controlled compared to their male counterparts. Our study confirmed these results in part; women in DIAB-CORE had higher total cholesterol values than men.…”

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

“…It appears that diabetic women compared with non-diabetic women may have a more severe degree of CVD risk factor abnormalities than their male counterparts or the impact of these factors on CVD mortality may be greater in diabetic women than in men (20). In particular, several parameters, such as BMI, TC, LDLC, apolipoprotein B and TG levels and small LDL particles (most of them related to insulin resistance), seem to provide stronger prediction of diabetes-related CHD events in women than in men (29,30,31,32). Furthermore, differences exist with respect to coagulation factors (higher levels of factor VIII), increased blood viscosity, endothelial dysfunction (higher levels of tissue plasminogen activator) and inflammation, as indicated by higher white cell blood count (28), a CHD and an allcause mortality prognostic factor (33).…”

Gender Differences in Composite Control of Cardiovascular Risk Factors Among Patients with Type 2 Diabetes

“…1,[8][9][10] A review of the literature shows that men with T2DM often have better cardiovascular risk profiles and outcomes compared with women with T2DM. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Women with diabetes have a three-to fivefold higher risk of developing CVD, and men have a two-to threefold higher risk compared with their respective counterparts without diabetes. 2,10,11,[14][15][16][17][25][26][27] Regardless, both men and women living with diabetes can lower their risk of CVD by adjusting modifiable factors below specific thresholds such as glycosylated hemoglobin A1c (HbA1c) level <7%, blood pressure (BP) <130/80 mm Hg, and low-density lipoprotein (LDL) cholesterol level <100 mg/dL.…”

“…23 More evidence is needed to determine why gender differences in CVD risk factor control continue, and some postulate that this difference may be due to variances in clinical practice. In a systematic review of gender differences related to treatment of CVD, there was a 20% significant difference in cardiovascular-related outcomes by gender 31 such that women demonstrated more adverse outcomes in the majority of the studies reviewed.…”