Gender differences in screening for glucose perturbations, cardiovascular risk factor management and prognosis in patients with dysglycaemia and coronary artery disease: results from the ESC-EORP EUROASPIRE surveys

Abstract

Background 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. 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. Methods The 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. Results Known 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). Conclusions Guideline-recommended risk factor control is poorer in dysglycemic women than men. This may contribute to the worse prognosis in CAD women with known diabetes.

Gender differences in changes in metabolic syndrome status and its components and risk of cardiovascular disease: a longitudinal cohort study

“…Therefore, the greater exposure of women to metabolic risk factors before diabetes and hypertension incidence may help to explain the stronger impact of high BP and FPG for CVD events in women than men [ 46 ]. Finally, it has been shown that guideline-recommended risk factor control is poorer in dysglycemic women than men and this may contribute to the worse prognosis in women with dysglycaemia and coronary artery disease (CAD) [ 47 ].…”

Gender disparities in time-to-initiation of cardioprotective glucose-lowering drugs in patients with type 2 diabetes and cardiovascular disease: a Danish nationwide cohort study

“…Most often, undertreatment is explained by suboptimal medicine adherence, and multiple clinical and observational studies have shown lower adherence to prescribed CVD medication in women than in men (as summarized in a recent editorial by Sederholm et al [ 4 ]). Specifically in patients with type 2 diabetes, it has recently been shown, that female patients have poorer guideline-recommended risk factor control compared with male patients [ 29 ]. Subclinical atherosclerosis is more prevalent in non-diabetic women than men with signs of insulin resistance and uncontrolled risk factors [ 30 ], and may indicate why female T2DM patients face a higher risk of CVD than men [ 2 ] Lower rates of drug initiation may be an important part of under treatment that is often overlooked.…”

Gender-associated cardiometabolic risk profiles and health behaviors in patients with type 2 diabetes: a cross-sectional analysis of the Joint Asia Diabetes Evaluation (JADE) program

“… 3 , 5 , 39 Changes in hormonal profiles, negative emotions, physical inactivity, and insufficient ongoing support for self-management might worsen these gender differences. 40 , 41 , 42 In high-income countries, social disparity was associated with high prevalence of overweight or obesity in both gender with larger effect size in women. 5 In our study, the low level of education might contribute to the higher frequency of central obesity in women.…”