Sex Disparities in Treatment of Cardiac Risk Factors in Patients With Type 2 Diabetes

  1. Deborah J. Wexler, MD, MSC1,
  2. Richard W. Grant, MD, MPH2,
  3. James B. Meigs, MD, MPH2,
  4. David M. Nathan, MD1 and
  5. Enrico Cagliero, MD1
  1. 1Diabetes Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  2. 2General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  1. Address correspondence and reprint requests to Deborah J. Wexler, MD, MSc, Diabetes Unit, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114. E-mail: dwexler{at}partners.org

Abstract

OBJECTIVE—Diabetes eliminates the protective effect of female sex on the risk of coronary heart disease (CHD). We assessed sex differences in the treatment of CHD risk factors among patients with diabetes.

RESEARCH DESIGN AND METHODS—A cross-sectional analysis included 3,849 patients with diabetes treated in five academic internal medicine practices from 2000 to 2003. Outcomes were stratified by the presence of CHD and included adjusted odds ratios (AORs) that women (relative to men) were treated with hypoglycemic, antihypertensive, lipid-lowering medications or aspirin (if indicated) and AORs of reaching target HbA1c, blood pressure, or lipid levels.

RESULTS—Women were less likely than men to have HbA1c <7% (without CHD: AOR 0.84 [95% CI 0.75–0.95], P = 0.005; with CHD: 0.63 [0.53–0.75], P < 0.0001). Women without CHD were less likely than men to be treated with lipid-lowering medication (0.82 [0.71–0.96], P = 0.01) or, when treated, to have LDL cholesterol levels <100 mg/dl (0.75 [0.62–0.93], P = 0.004) and were less likely than men to be prescribed aspirin (0.63 [0.55–0.72], P < 0.0001). Women with diabetes and CHD were less likely than men to be prescribed aspirin (0.70 [0.60–0.83], P < 0.0001) or, when treated for hypertension or hyperlipidemia, were less likely to have blood pressure levels <130/80 mmHg (0.75 [0.69–0.82], P < 0.0001) or LDL cholesterol levels <100 mg/dl (0.80 [0.68–0.94], P = 0.006).

CONCLUSIONS—Women with diabetes received less treatment for many modifiable CHD risk factors than diabetic men. More aggressive treatment of CHD risk factors in this population offers a specific target for improvement in diabetes care.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted November 21, 2004.
    • Received October 21, 2004.
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