Cardiovascular care for women with diabetes lags behind care for men

New research suggests that women with type 2 diabetes are less likely to receive comprehensive cardiovascular prevention than their male counterparts.

Presented at the annual meeting of the European Association for the Study of Diabetes (EASD), the results of the analysis indicate that women were less likely to meet treatment goals for cardiovascular management than their male counterparts and were less likely to receive medical therapy as directed.

“Despite the evidence for benefits for managing cardiovascular risk factors (such as lowering blood pressure and cholesterol levels) in people with type 2 diabetes, an unacceptable proportion of affected women do not reach recommended treatment goals, ”said lead author Giulia Ferrannini, MD, of the Karolinska Institutet, Stockholm, Sweden, in a statement. “Cardiovascular disease is the leading killer of women, but it’s never been more preventable and treatable. The reasons why women do not receive the same level of treatment as men are complex and require further investigation so that women with type 2 diabetes can be treated more effectively.

With improving cardiovascular care for women, especially those with diabetes, a major focus of research in the community, Ferrannini and colleagues at the Karolinska Institute, Population Health Research Institute, and Eli Lilly and Company have completed this study with the aim of evaluating the subject through analysis of the REWIND trial. To accomplish this, the present study was designed as an assessment of a subset of REWIND participants with baseline and follow-up data related to blood pressure, LDL-C and HDL-C from the trial. REWIND.

In short, the REWIND trial was a multicenter, randomized, placebo-controlled trial conducted in 24 countries, involving more than 10,000 patients with type 2 diabetes and varying levels of cardiovascular risk. The trial had a mean follow-up of 5.4 years and was designed to compare the effects of dulaglutide versus placebo treatment with a composite primary outcome measure non-fatal myocardial infarction, non-fatal stroke. fatal or cardiovascular death. The trial ultimately concluded that dulaglutide was associated with a 12% lower risk of the composite primary outcome (RR: 0.88 [95% CI, 0.79-0.99]; P= .026).

Of the 9,901 patients in the REWIND trial, 46.3% were female. Of note, the men included in the study were more likely to have a history of cardiovascular disease than their female counterparts (41.4% vs. 20.0%; P <.001). After analysis, the results indicate that the majority of women met clinically relevant treatment goals for blood pressure and cholesterol at baseline, but a smaller proportion of women were on target for ACE use / ARB (80% vs. 83%), lipid control or statin use (73% vs. 81% or aspirin use (P <.001 for all).

Further analysis suggested that women had a lower risk for all of the cardiovascular outcomes included in the study except fatal or non-fatal strokes, which the researchers said were also seen in one. subgroup of patients with no history of cardiovascular disease at baseline. Additionally, the researchers pointed out that women with a history of cardiovascular disease had a similar risk of stroke, hospitalization for heart failure, all-cause mortality, and cardiovascular mortality compared to their male counterparts.

“It is important to take into account all the gender disparities that exist in the real world that prevent women with diabetes from maintaining such an advantage, including the delay to diagnosis, the use of invasive revascularization procedures. and the use of treatments recommended by the guidelines. Women with type 2 diabetes have a high cardiovascular risk and should not be neglected in its overall management, ”added Ferrannini.

This study, “Gender differences in cardiovascular risk, treatment, and outcome: a post-hoc analysis of the REWIND trial,” was presented at EASD 2021.