GENDER-RELATED DIFFERENCES IN CARDIOVASCULAR RISK ASSESSMENT AND MANAGEMENT IN PRIMARY CARE: INSIGHTS FROM THE PARADIGM STUDY

Abstract

BACKGROUND: For the primary prevention of cardiovascular (CV) disease, the Canadian dyslipidemia guidelines support the use of the Framingham Risk Score (FRS). However, it is not known whether physicians’ chosen method and performance of CV risk assessment and guideline adherence differ between men and women in “real world” clinical practice. METHODS: Between March 2009 and March 2010, 105 primary care physicians across Canada prospectively collected data for the PARADIGM (Primary cARe AuDIt of Global risk Management) study. This included 3015 ambulatory men ( 40 years old) and women ( 50 years old) without known CV disease or diabetes, and without lipid-lowering medications at baseline. Physicians determined the CV risk of each patient, and reported the risk stratification method utilized, with subsequent treatment decisions. RESULTS: Of the 3015 patients (mean age 56 years, 59% male), men were significantly younger, with lower LDL-C (median 3.50mmol/L vs. 3.60mmol/L), lower total cholesterol (median 5.48mmol/L vs. 5.80mmol/L), and higher systolic blood pressure (all p<0.001). Overall, physicians reported utilizing FRS in 34.0%, subjective clinical judgment in 28.5%, hsCRP in 15.8%, counting of risk factors in 12.1%, Reynolds Risk Score in 8.6%, and other Methods in 0.9% of patients. Their reported risk stratification method use was similar for male and female patients. There was only fair agreement between the risk stratifications reported by the physician and the study-calculated FRS: overall (kappa1⁄40.25), among men (kappa1⁄40.22) and women (kappa1⁄40.26). According to the study-calculated FRS, 32.5% of men and 8.2% of women were classified as high risk. In contrast, physicians identified 14.8% of men and 10.3% of women as high risk.