Differences in Treating Heart Disease in Men and Women With Diabetes

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Wexler DJ, Grant RW, Meigs JB, et al.: Sex Disparities in Treatment of Cardiac Risk Factors in Patients With Type 2 Diabetes. Diabetes Care 28:514-520, 2005.

What is the problem and what is known about it so far?

Coronary heart disease causes the blood vessels that flow to the heart to become hardened and blocked, leading to heart damage. People with diabetes are more likely to get coronary heart disease than people without diabetes.

During the past 30 years, the number of deaths by coronary heart disease has gone down in the general population but has gone up among women with diabetes. Although healthy women usually have a lower risk of coronary heart disease than men, women with diabetes are up to 10 times more likely to die from coronary heart disease.

Researchers believe that in the past, doctors did not focus on treating conditions that lead to coronary heart disease in women because women were generally at a lower risk for getting coronary heart disease than men. Today, doctors are more aware of the increased risk for coronary heart disease in women with diabetes, but differences in treatment still exist.

Why did the researchers do this particular study?

Researchers wanted to find out why more women with diabetes were getting coronary heart disease and whether these women were given different treatment options and medical advice about conditions that lead to coronary heart disease, such as high blood pressure and high cholesterol. They were also looking for ways to help women with diabetes better control their blood glucose in order to decrease their risk for coronary heart disease.

Who was studied?

A total of 3,849 patients with diabetes in the Boston area were studied. About 50% of them were women who came from different ethnic backgrounds. Some did not speak English. More than 80% of the participants had high blood pressure, high cholesterol, or had already developed coronary heart disease.

How was the study done?

Researchers reviewed medical charts and billing records to select the study participants. They collected information on each patients' medical history and what medications they were taking. They looked at the differences in how men and women with diabetes were treated for conditions that lead to coronary heart disease.

What did the researchers find?

Women were less likely than men to be treated for high blood pressure, high cholesterol, and low blood glucose conditions. Once treated, they were less likely to reach their treatment goals. They also were less likely to take aspirin or cholesterol-lowering medications that lower the risk for coronary heart disease.

What are the limitations of the study?

It is possible that some women took over-the-counter aspirin, acetaminophen, or ibuprofen to reduce the risk of coronary heart disease but did not report the medication to their doctors. All the participants were treated at city hospitals, so it is difficult to apply the results to women who were treated elsewhere.

What are the implications of the study?

Although doctors are more aware of the increased risk of coronary heart disease for women with diabetes, the study indicates that men and women still receive different kinds of treatment. Women with diabetes need to receive better care for conditions such as high blood pressure, high cholesterol, and other conditions that lead to coronary heart disease.

FOR MORE INFORMATION

Keeping Your Heart Healthy Despite Diabetes ( ADA , Alexandria , VA , 2002)

Diabetes and Cardiovascular (Heart) Disease

Sex Differences in the Prognostic Importance of Diabetes in Patients With Ischemic Heart Disease Undergoing Coronary Angiography, by M.M. Graham and Colleagues. Diabetes Care 26:3142–3147, 2003