Abstract P334: Gender Disparities in Cholesterol Control Among Patients with Diabetes

Abstract

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/m 2 ), 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. Table LDL-c (mg/dL) by gender and baseline CAD status Women Men Mean difference Mean (SD) Median Mean (SD) Median Baseline 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 Follow-up 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