Heart risk factor control worse in diabetic women

NEW YORK (Reuters Health) - Deaths from cardiovascular disease are declining among men with diabetes, but not women, and poorer control of blood pressure and cholesterol levels may be to blame, a new study suggests.

Among diabetic patients with existing cardiovascular disease, Dr. Assiamira Ferrara of Kaiser Permanente in Oakland, California and colleagues found, women were 5.4 percent less likely than men to have systolic blood pressures at recommended levels, and 5.9 percent less likely to have their "bad" LDL-cholesterol under control.

"Women with diabetes should be more concerned about their risk of developing cardiovascular disease," Ferrara told Reuters Health in an interview, adding that diabetic women should make sure that their doctor is doing the appropriate screening for blood pressure and cholesterol and keeping these two parameters under control.

Over the past 25 years, Ferrara and her colleagues note, deaths from cardiovascular disease among men with and without diabetes have fallen. While women overall are also experiencing a decline in deaths from heart disease, women with diabetes are not, they explain in the medical journal Diabetes Care.

To determine if gender differences in control of heart disease risk factors might help explain this disparity, the researchers looked at 8,821 men and women with diabetes belonging to 10 different managed care plans in the U.S. About one-third had a history of cardiovascular disease.

Among people with no heart or blood vessel disease, there was no difference in the percentage of men and women who had their blood sugar, blood pressure or LDL cholesterol under control.

But for those who did have cardiovascular disease, 41.2 percent of men had systolic blood pressure (the top number in a blood pressure reading) of 140 mm/Hg or greater, compared to 46.6 percent of women. And 22.4 percent of men had LDL-cholesterol levels above the recommended 3.35 mmol/l, compared to 28.3 percent of women. Women whose LDL levels were too high were 9 percent less likely than their male counterparts to be receiving intensive medication to lower their LDL.

Given that better LDL-cholesterol and blood pressure control is known to reduce heart disease-related mortality among people with diabetes, the researchers say, "more intense treatment in women with diabetes offers the opportunity to reduce the observed gap between men and women with diabetes in the reduction of CVD mortality."

SOURCE: Diabetes Care, January 2008.