Race‐Sex Differences in Statin Use and Low‐Density Lipoprotein Cholesterol Control Among People With Diabetes Mellitus in the Reasons for Geographic and Racial Differences in Stroke Study

Abstract

BackgroundStatin therapy is a cornerstone of cardiovascular disease risk reduction for people with diabetes mellitus. Past reports have shown race‐sex differences in statin use in general populations, but statin patterns by race and sex in those with diabetes mellitus have not been thoroughly studied.Methods and ResultsOur sample of 4288 adults ≥45 years of age with diagnosed diabetes mellitus who had low‐density lipoprotein cholesterol (LDL‐C) >100 mg/dL or were taking statins recruited for the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2007. Exposures included race‐sex groups (white men [WM], black men [BM], white women [WW], black women [BW]) and factors that may influence healthcare utilization. Proportions and prevalence ratios were calculated for statin use and LDL‐C control. Statin use for WM, BM, WW, and BW was 66.0%, 57.8%, 55.0%, and 53.6%, respectively (P<0.001). After adjustment for healthcare utilization factors, statin use was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.96 [0.89‐1.03], 0.86 [0.80‐0.92], and 0.87 [0.81‐0.93], respectively, P<0.001). LDL‐C control among those taking statins for WM, BM, WW, and BW was 75.3%, 62.7%, 69.0%, and 56.0%, respectively (P<0.001). After adjustment, LDL‐C control was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.85 [0.79‐0.93], 0.89 [0.82‐0.96], and 0.73 [0.67‐0.80], respectively, P<0.001).ConclusionsRace‐sex disparities in statin use and LDL‐C control were only partly explained by factors influencing health services utilization. Healthcare provider awareness of these disparities may help to close the observed race‐sex gaps in statin use and LDL‐C control among people with diabetes mellitus.

Cardiovascular Disease in Type 2 Diabetes: A Review of Sex-Related Differences in Predisposition and Prevention

“…50 Nevertheless, some studies found that women with T2DM were less likely to be prescribed statin (or lipidlowering treatment) when compared with male counterparts. 41,45,[52][53][54] Moreover, numerous observational and cross-sectional studies had shown that a lower proportion of women with T2DM were on target regarding LDL cholesterol when compared with men ( Table 2). 27-29,31-42,52,55-58 d Importantly, when mean LDL cholesterol levels (or the on-target percentage) were stratified according to statin therapy, women on statin therapy 54 and untreated women tended to have worse control of LDL cholesterol than men.…”

“…41,45,[52][53][54] Moreover, numerous observational and cross-sectional studies had shown that a lower proportion of women with T2DM were on target regarding LDL cholesterol when compared with men ( Table 2). 27-29,31-42,52,55-58 d Importantly, when mean LDL cholesterol levels (or the on-target percentage) were stratified according to statin therapy, women on statin therapy 54 and untreated women tended to have worse control of LDL cholesterol than men. 32,27 The reasons for such a disparity are not completely understood, but it is possible that female sex per se confers higher LDL cholesterol levels.…”

Baseline Visual Acuity of Women with Diabetic Macular Edema is Worse than Men: A Case-Control Study

“…Different previous studies evaluated the relationship between the gender and other coexisting diseases with DM. [5][6][7][8][9][10][11][12] In a study by Al-Salameh et al, the association between gender and control of diabetes and other cardiovascular risk factors in patients with type 2 DM were investigated. 6 In the study it was revealed that women were less likely to be smokers or ex-smokers, and less likely to have cardiovascular disease at the baseline than men.…”

“…Gamboa et al, evaluated the race and gender differences in statin use and LDL cholesterol control among the DM patients. 8 The recruited the patients with a LDL level >100 mg/dL, or were taking statins. In the study the authors divided the included patients into four groups which were white women, black women, white men, and black men, respectively.…”

“…[1][2][3][4] Several studies were conducted to assess the relationship between the gender and end-organ damage of diabetes mellitus. [5][6][7][8][9][10][11][12][13] Previous studies investigated different organ systems and cardiovascular risk profiles, lipid profiles, risk of diabetic foot, risk factors for malignancy, and bone changes were evaluated in regard to gender difference in diabetic population. [6][7][8][9][10][11][12] Diabetic retinopathy (DR) is an important and devastating end-organ damage of DM which affects approximately one fifth of the patients after 20 years of disease duration.…”