Abstract 17126: Tackling Cardiovascular Disease Risk in Primary Care: Does Sex Matter?
Purpose: To ascertain whether men and women respond differently to an intervention intended to decrease cardiovascular disease (CVD) risk in primary care (PC) through individualized systematic risk factor screening, risk-weighted behavioral counseling and pharmacological treatment.
Methods: We studied two geographically diverse PC practices in Nova Scotia, Canada, with differing reimbursement models vs a comparison group. Patients completed a health risk assessment (HRA) and readiness to change assessment that triggered an intervention individualized around both parameters with 1-year follow-up and a final HRA. The primary endpoint was the proportion of subjects with moderate and high baseline 10-year Framingham Risk Scores reducing risk by 10% and 25%, respectively. Sex-differences in response to the intervention were explored.
Results: 1509 intervention patients enrolled; 72% completed the study. Results are presented for 561 subjects with moderate or high baseline Framingham risk but no diabetes or established CVD. Mean age was 55.4 years; 57.8% were female. 43% vs 31% controls achieved the primary endpoint (p=0.06, ARR = 12%, RRR = 38%, NNT=9). Females (ARR=15%, RRR=46%, NNT= 7) did better than males (ARR=5.2%, RRR=17.2%, NNT=20). When comparing sexes, there was significantly greater reduction in systolic blood pressure (p< 0.001) and a higher increase in HDL cholesterol (p=0.04) for females. Significantly more (p < 0.0001) females changed their metabolic syndrome status (prevalence 93.5% vs 58.6% pre and post intervention, respectively) vs. males (59.5% vs. 46.8% pre and post intervention, respectively). The specific metabolic syndrome risk factors that drove the difference included waist circumference (p <0.0001), HDL cholesterol (p=0.03) and blood pressure (p=0.04). These results were obtained largely through lifestyle modification; drug use did not change significantly.
Conclusion: In an intervention to improve CVD risk in primary care, women did better than men. Differences were seen especially around improved metabolic risk, predominantly as a result of lifestyle change. These findings suggest that prevention programs may need to modify their approaches according to patient sex.
- © 2011 by American Heart Association, Inc.