Sex disparities in cardiovascular risk and risk factor Management in Type 2 diabetes: A population-based study of the clinical practice research datalink

Wright, Alison K.; Kontopantelis, Evangelos; Emsley, Richard; Buchan, Iain; Mamas, Mamas A.; Sattar, Naveed; Ashcroft, Darren M.; Rutter, Martin K.

Abstract

Background: Historically, women developing type 2 diabetes (T2DM) have experienced a 27–50% greater increase in their risk for cardiovascular disease (CVD) than men developing T2DM.

Objectives: With recent changes in UK clinical practice for diabetes care, we aimed to determine if this gender disparity persists in contemporary data and if any disparity could be explained by gender biases in diabetes management.

Methods: Using the Clinical Practice Research Datalink (CPRD) linked to hospital admission and death data, we identified 79,985 people with incident T2DM between 2006–2013 and 386,547 age-sex-practice-matched controls without diabetes. The primary endpoint was the first record of fatal and non-fatal myocardial infarction, stroke or cardiovascular death, identified from primary care, hospital and death records. Sex-stratified Cox models were used to assess cardiovascular risk.

Results: Compared to women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted HR 1.20 [95% CI 1.12–1.28]) with similar corresponding data in men (HR 1.12 [1.06–1.19]) leading to a non-significant 7% excess relative risk in women (risk ratio 1.07 [0.98–1.17]). However, some important sex differences in the management of risk factors were observed. Compared to men with T2DM, women with T2DM were more likely to be obese, hypertensive and have hypercholesterolaemia but were less likely to be prescribed statins and ACE inhibitors, especially if they had CVD. In T2DM subgroups with CVD, women were less likely to receive antiplatelet agents than men.

Conclusions: Compared to men developing T2DM, women with T2DM do not have a significantly higher relative increase in CVD risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes care. Particular attention is required for women with abnormal cardiovascular risk factors, who may be receiving suboptimal preventative care.

Citation

Wright, A. K., Kontopantelis, E., Emsley, R., Buchan, I., Mamas, M. A., Sattar, N., …Rutter, M. K. (2019, August). Sex disparities in cardiovascular risk and risk factor Management in Type 2 diabetes: A population-based study of the clinical practice research datalink. Poster presented at 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Pennsylvania Convention Center, Philadelphia, PA, USA

• Presentation Conference Type: Poster
• Conference Name: 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management
• Conference Location: Pennsylvania Convention Center, Philadelphia, PA, USA
• Start Date: Aug 24, 2019
• End Date: Aug 28, 2019
• Deposit Date: Jun 27, 2023
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1002/pds.4864