LOS ANGELES —Women with type 2 diabetes may be treated for dyslipidemia less aggressively than men, and therefore may be at higher risk of developing cardiovascular disease, Dr. Quyen Ngo-Metzger reported at the annual meeting of the Society of General Internal Medicine.
Coronary heart disease is a leading cause of death among women and among all patients with type 2 diabetes. Diabetes confers a four times greater risk of coronary heart disease in women, compared with a doubling of risk in men, said Dr. Ngo-Metzger, an assistant professor of medicine at the University of California, Irvine.
Dr. Ngo-Metzger and her associates examined quality of care in a sample of 4,879 men and 7,654 women with type 2 diabetes (mean age 56 years) who were treated at 16 Kaiser Permanente Georgia practices in 2002.
About two-thirds of men and women received recommended hemoglobin A1c and cholesterol testing. About one-quarter of men (25%) and women (27%) achieved glycemic control (a hemoglobin A1c value of less than 7%).
Overall, 72% of men and 68% of women achieved LDL-cholesterol levels of less than 130 mg/dL; this difference was deemed statistically significant.
After adjustment of the data for age and comorbid conditions in multivariate analyses, men were 26% more likely than women to have an LDL-cholesterol value of less than 130 mg/dL.
Among high-risk patients with known coronary heart disease, 86% of men and 76% of women had an LDL-cholesterol level of less than 130 mg/dL; after adjustment for age and comorbidity, men were twice as likely as women to have lipid control at this cutoff.
In addition, 56% of men and 44% of women had an LDL-cholesterol concentration of less than 100 mg/dL; after adjustment, men were 64% more likely than women to have achieved control using this more stringent definition, she reported.
Overall, 43% of men were prescribed statins, compared with 37% of women; this difference was found to be statistically significant, Dr. Ngo-Metzger said.
It is unlikely that the gender disparities were due to lack of access to care, more comorbidities in women, gender differences in choosing to have cholesterol measured, or lower compliance with statins among women, she added.
“Clinicians need to be reminded of high coronary heart disease mortality among women with diabetes. Diabetic women with high cholesterol need to have their dyslipidemia treated aggressively,” Dr. Ngo-Metzger said.
Further research is needed, she noted, to determine whether the differences reflect providers' prescribing habits or personal preferences among women and men.