Abstract
BackgroundGender disparities in the management of dysglycaemia, defined as either impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), in coronary artery disease (CAD) patients are a medical challenge. Recent data from two nationwide cohorts of patients suggested no gender difference as regards the risk for diabetes-related CV complications but indicated the presence of a gender disparity in risk factor management. The aim of this study was to investigate gender differences in screening for dysglycaemia, cardiovascular risk factor management and prognosis in dysglycemic CAD patients.MethodsThe study population (n = 16,259; 4077 women) included 7998 patients from the ESC-EORP EUROASPIRE IV (EAIV: 2012–2013, 79 centres in 24 countries) and 8261 patients from the ESC-EORP EUROASPIRE V (EAV: 2016–2017, 131 centres in 27 countries) cross-sectional surveys. In each centre, patients were investigated with standardised methods by centrally trained staff and those without known diabetes were offered an oral glucose tolerance test (OGTT). The first of CV death or hospitalisation for non-fatal myocardial infarction, stroke, heart failure or revascularization served as endpoint. Median follow-up time was 1.7 years. The association between gender and time to the occurrence of the endpoint was evaluated using Cox survival modelling, adjusting for age.ResultsKnown diabetes was more common among women (32.9%) than men (28.4%, p < 0.0001). OGTT (n = 8655) disclosed IGT in 17.2% of women vs. 15.1% of men (p = 0.004) and diabetes in 13.4% of women vs. 14.6% of men (p = 0.078). In both known diabetes and newly detected dysglycaemia groups, women were older, with higher proportions of hypertension, dyslipidaemia and obesity. HbA1c was higher in women with known diabetes. Recommended targets of physical activity, blood pressure and cholesterol were achieved by significantly lower proportions of women than men. Women with known diabetes had higher risk for the endpoint than men (age-adjusted HR 1.22; 95% CI 1.04–1.43).ConclusionsGuideline-recommended risk factor control is poorer in dysglycemic women than men. This may contribute to the worse prognosis in CAD women with known diabetes.
Highlights
Gender disparities in the management of dysglycaemia, defined as either impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), in coronary artery disease (CAD) patients are a medical challenge
This may contribute to the worse prognosis in CAD women with known diabetes
The main objective of the present study is to investigate gender differences in screening for dysglycaemia, CV risk factor management in a large homogeneous cohort of dysglycemic patients with verified CAD subjected to a standardised examination within the framework of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV and V [20, 21]
Summary
Gender disparities in the management of dysglycaemia, defined as either impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), in coronary artery disease (CAD) patients are a medical challenge. Dysglycaemia, defined as the presence of either impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), represents a major cause of morbidity and mortality worldwide, mainly due to its high risk of vascular complications, including coronary artery disease (CAD) [1, 2] International guidelines recommend both screening for glucose perturbations and a comprehensive cardiovascular (CV) risk factor control in people with dysglycaemia and CAD [3]. More recent data from two nationwide cohorts of patients with atherosclerotic disease manifestations partially revisited these assumptions, suggesting no difference between women and men as regards the risk for diabetes-related CV complications, but confirming the existence of a gender disparity in risk factor management [17, 18] The results of such studies are, partly conflicting and may be diverse among various populations [19]. One reason is that these observations were made based on registry-derived information i.e. not on standardised investigations, which in itself may cause bias, and another that these populations were domestic
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