Abstract P334: Gender Disparities in Cholesterol Control Among Patients with Diabetes
Background: It has been reported that women often receive less aggressive primary and secondary prevention for cardiovascular disease. Diabetes decreases the cardiovascular protection that women experience, and is considered a coronary heart disease equivalent. National diabetes guidelines thus recommend similar LDL-cholesterol (LDL-c), blood pressure, and hemoglobin A1c (HbA1c) goals for men and women.
Methods: We conducted a retrospective, longitudinal study in a cohort of 6,573 patients with incident type 2 diabetes at Kaiser Permanente Colorado (2000-2008). We examined LDL-c, blood pressure, and HbA1c at the time of diagnosis (baseline) and after one year follow-up. We identified baseline coronary artery disease (CAD) via diagnosis codes.
Results: Women and men had similar age and race distributions. Women were more likely to be never smokers and had higher BMI (34.0 vs. 31.9 kg/m2), while men were more likely to be former smokers and have CAD (20.9% vs. 9.8%). Men had slightly higher baseline HbA1c, but the difference disappeared at follow-up. No gender differences were seen for blood pressure. Women had higher baseline LDL-c (Table, p-value <0.0001), with 79% of the initial difference persisting after one year (p-value <0.0001). Women were less likely to have LDL-c < 100 mg/dL at one year follow-up (50.7% vs. 57.2%). In both genders, LDL-c was lower among individuals with CAD than those without CAD. Baseline CAD accounted for 35% of the follow-up LDL-c gender difference. At follow-up, women were slightly less likely to be taking a statin (40% vs. 38%).
Conclusions: Even with population-based case-management programs aimed at cholesterol management, fewer women than men met the recommended LDL-c goal of < 100 mg/dL one year after diabetes diagnosis. Some of the difference can be attributed to differences in CAD prevalence. These findings suggest that diabetes is often not treated as a CAD equivalent in clinical care, and greater emphasis should be placed on primary CAD prevention among both men and women with diabetes.
|Mean (SD)||Median||Mean (SD)||Median|
|No CAD||121.5 (37.0)||119.0||117.4 (36.4)||115.0||4.1|
|CAD||94.0 (35.0)||88.0||89.1 (29.1)||86.0||4.9|
|Total||118.8 (37.7)||116.0||111.5 (36.8)||109.0||7.3|
|No CAD||106.0 (33.7)||102.0||102.2 (31.1)||100.0||3.8|
|CAD||86.5 (32.8)||82.0||82.9 (26.5)||79.0||3.6|
|Total||104.0 (34.1)||100.0||98.2 (31.2)||95.0||5.8|
- © 2012 by American Heart Association, Inc.