Gender Disparities in Control and Treatment of Modifiable Cardiovascular Disease Risk Factors Among Patients With Diabetes: Translating Research into Action for Diabetes (TRIAD).

  1. Assiamira Ferrara, MD, PhD (Assiamira.Ferrara{at}kp.org)1,
  2. Carol M. Mangione, M.D., M.S.P.H.2,
  3. Catherine Kim, M.D., M.P.H.3,
  4. David G Marrero, PhD4,
  5. David Curb, MD, MPH5,
  6. Mark Stevens, MSPH, MA6,
  7. Joseph V. Selby, M.D., M.P.H.1 and
  8. for the Translating Research into Action for Diabetes (TRIAD) Study Group
  1. 1Division of Research, Kaiser Permanente, Oakland, CA
  2. 2Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
  3. 3Departments of Internal Medicine and Obstetrics & Gynecology, University of Michigan, Ann Arbor MI
  4. 4Indiana University School of Medicine, Indianapolis, IN
  5. 5 Pacific Health Research Institute, Honolulu
  6. 6Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA

    Abstract

    Objective: Cardiovascular disease (CVD) mortality has decreased in men but not in women with diabetes. We investigated whether gender differences in control and treatment of CVD risk factors might underlie this disparity.

    Research Design and Methods: Cross-sectional analyses from a cohort of patients with diabetes sampled from 10 U.S. managed care health plans. Study endpoints included not being in control for CVD risk factors [≥140 mmHg for systolic blood pressure (SBP); ≥3.35 mmol/l for low density lipoprotein cholesterol (LDL-C); and ≥8.0% 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 1315 women and 1575 men with a CVD history, and 3415 women and 2516 men without a CVD history. 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 -5.4% (95% confidence interval [CI] -9.5 to -1.3)] and LDL-C [men 22.4%, women 28.3%; risk difference -5.9% (95% CI -9.9 to -1.8)]. There were no significant gender 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-C for women may contribute to the gender disparity in CVD mortality trends.

    Footnotes

      • Received June 29, 2007.
      • Accepted October 9, 2007.

    This Article

    1. Published online before print October 12, 2007, doi: 10.2337/dc07-1244
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