Diabetic Women Less Likely to Achieve LDL and BP Targets, Even With the Same Prescriptions

Posted Aug 29, 2008.By Miriam E. Tucker

WASHINGTON (EGMN) - Significantly fewer diabetic women than men achieved target LDL cholesterol and blood pressure levels despite equivalent medication prescriptions in a study of 211 underserved inner-city and rural patients.

Evidence suggests that diabetic women carry a greater risk both for the development of cardiovascular disease (CVD) and for mortality following an acute cardiac event than do either diabetic men or women without diabetes. The finding of gender-based differences in achieving lipid and blood pressure goals suggests that sex-based physiologic differences may account for the increased cardiovascular risk among women with diabetes, Carol J. Homko, Ph.D., and her associates said in a poster presented at the annual meeting of the American Association of Diabetes Educators.

"I believe the message for clinicians is that women with diabetes are at very high risk for CVD mortality and need to be aggressively treated to target in regards to blood pressure and cholesterol, as well as glucose," Dr. Homko, of Temple Telemedicine Research Center, Philadelphia, said in a follow-up interview.

The patients whose charts were reviewed were enrolled in a telemedicine trial to reduce CVD risk. All patients had type 2 diabetes and a 10% or greater CVD risk on the Framingham 10-year absolute risk index; however, they did not have overt heart disease. There were 123 women and 88 men, with no differences in mean age (61.1 and 59.2 years, respectively), body mass index (34.7 vs 32.8 kg/m²) or Framingham risk (20.4% vs. 21.2%). Only 37.4% of the women and 40.9% of the men had achieved a hemoglobin A

Total cholesterol levels were significantly higher among women, compared with men (201.4 vs. 184.7 mg/dL). Fewer women had total cholesterol levels of less than 200 mg/dL (57% vs. 73%), and significantly fewer were treated to an LDL cholesterol target of less than 100 mg/dL (32.5% vs. 47.7%). Similarly, mean blood pressure (BP) was higher among the women (145/79 vs. 141/83 mm Hg) and significantly fewer women achieved a target BP of less than 130/80 mm Hg (17.9% vs. 28.4%).

Despite these differences, rates of insulin, aspirin, antihypertensive, and statin therapy did not differ between the two groups, Dr. Homko and her associates reported.

The reason why the women in this study were less likely to be treated to target despite receiving the same pharmacotherapy that the men received is unclear. It may be that women were less compliant with their medications, although most previous studies have found women to be more compliant than men, Dr. Homko said in the interview.

"We only looked at prescription rates," she said. "We did find that the women in our study had significantly lower rates of exercise tolerance, indicating that the men were more physically active. Therefore, the men may have experienced greater drops in BP and cholesterol because of the combination of medication and lifestyle." And, she added, there may be some physiologic difference in response to medications between the two sexes.

The next step will be to examine gender-based differences in coagulation and endothelial function, she said.

Dr. Homko serves on the advisory board of Abbott Diabetes Care.