Sex differences in cardiovascular risk management for people with diabetes in primary care: a cross-sectional study

Marit de Jong; Rimke C Vos; Rianneke de Ritter; Carla J van der Kallen; Simone J Sep; Mark Woodward; Coen DA Stehouwer; Michiel L Bots; Sanne Ae Peters

doi:10.3399/bjgpopen19X101645

Sex differences in cardiovascular risk management for people with diabetes in primary care: a cross-sectional study

BJGP Open. 2019 Jul 23;3(2):bjgpopen19X101645. doi: 10.3399/bjgpopen19X101645. Print 2019 Jul.

Authors

Marit de Jong¹, Rimke C Vos^{2

3}, Rianneke de Ritter^{4

5}, Carla J van der Kallen^{6

7}, Simone J Sep^{8

9}, Mark Woodward^{10

11

12}, Coen DA Stehouwer^{13

14}, Michiel L Bots¹⁵, Sanne Ae Peters^{16

17}

Affiliations

¹ PhD Student, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands m.dejong-29@umcutrecht.nl.
² Assistant Professor, Department of Public Health and Primary Care / LUMC-Campus, Leiden University Medical Center, The Hague, The Netherlands.
³ Assistant Professor, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
⁴ PhD student, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
⁵ PhD student, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
⁶ Assistant Professor, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
⁷ Assistant Professor, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
⁸ Senior Researcher, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
⁹ Senior Researcher, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
¹⁰ Professor, The George Institute for Global Health, University of Oxford, Oxford, UK.
¹¹ Professor, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
¹² Professor, Department of Epidemiology, Johns Hopkins University, Baltimore, USA.
¹³ Professor, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁴ Professor, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
¹⁵ Professor, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁶ Associate Professor, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁷ Associate Professor, The George Institute for Global Health, University of Oxford, Oxford, UK.

Abstract

Background: Diabetes is a stronger risk factor for cardiovascular complications in women than men.

Aim: To evaluate whether there are sex differences in cardiovascular risk management in patients with diabetes in primary care.

Design & setting: A cross-sectional study was undertaken using data from 12 512 individuals with diabetes within the Dutch Julius General Practitioners Network (JGPN) from 2013.

Method: Linear and Poisson regression analyses were used to assess sex differences in risk factor levels, assessment, treatment, and control.

Results: No sex differences were found in HbA1c levels and control, while small differences were found for cardiovascular risk management. Blood pressure levels were higher (mean difference [MD] 1.09 mmHg; 95% confidence intervals [CI] = 0.41 to 1.77), while cholesterol levels (MD -0.38 mmol/l; 95% CI = -0.42 to -0.34) and body mass index ([BMI] MD -1.79 kg/m²; 95% CI = -2.03 to 1.56) were lower in men than women. Risk factor assessment was similar between sexes, apart from high-density lipoprotein cholesterol (HDL-c), which was more commonly assessed in women (risk ratio [RR] 1.16; 95% CI = 1.13 to 1.20). Among those with a treatment indication for prevention, women with cardiovascular disease (CVD) were less likely to receive lipid-lowering drugs (RR 0.84; 95% CI = 0.76 to 0.93) than men, while women without CVD were more likely to receive lipid-lowering drugs (RR 1.16; 95% CI = 1.04 to 1.2). Among those treated, women were more likely to achieve systolic blood pressure (SBP) control (RR 1.06; 95% CI = 1.02 to 1.10) and less likely to achieve low-density lipoprotein cholesterol (LDL-c) control (RR 0.88; 95% CI = 0.85 to 0.91) than men.

Conclusion: In this Dutch primary care setting, sex differences in risk factor assessment and treatment of people with diabetes were small. However, women with diabetes were less likely to achieve control for LDL-c and more likely to achieve blood pressure control than men with diabetes.

Keywords: cardiovascular risk management; diabetes mellitus; general practice; primary health care; sex characteristics.

Grants and funding

MR/P014550/1/MRC_/Medical Research Council/United Kingdom