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Sex differences in risk factor management of coronary heart disease across three regions
Min Zhao1, Ilonca Vaartjes2,3, Ian Graham4
1Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Women with coronary heart disease (CHD) face worse risk factor management than men, particularly in achieving treatment targets. Regional variations exist, with disparities smaller in Europe compared to Asia and the Middle East.
Area of Science:
- Cardiology
- Public Health
- Sex Differences in Medicine
Background:
- Established coronary heart disease (CHD) requires effective risk factor management for secondary prevention.
- Understanding sex-based disparities in managing CHD risk factors is crucial for targeted interventions.
- Previous research indicates potential differences in healthcare utilization and outcomes between men and women with cardiovascular disease.
Purpose of the Study:
- To investigate sex differences in the management of risk factors for patients with established coronary heart disease (CHD).
- To assess how demographic variations influence potential sex differences in CHD risk factor management.
- To evaluate adherence to guideline-recommended treatment and lifestyle targets in men and women with CHD.
Main Methods:
- Recruitment of 10,112 patients with CHD from Europe, Asia, and the Middle East (2012-2013).
- Assessment of adherence to treatment and lifestyle targets using a Cardiovascular Health Index Score (CHIS).
- Age-adjusted regression models to compare risk factor management between women and men.
Main Results:
- Women were less likely than men to achieve targets for total cholesterol, LDL cholesterol, and glucose, and were less physically active and more likely to be obese.
- Women demonstrated better blood pressure control and were more likely to be non-smokers compared to men.
- Overall, women were less likely to meet all treatment targets or achieve an adequate CHIS, though no significant differences were observed for all lifestyle targets. Sex disparities were smaller in Europe than in Asia and the Middle East.
Conclusions:
- Risk factor management for secondary prevention of CHD is generally poorer in women compared to men.
- Significant sex disparities exist in achieving treatment targets, with variations influenced by geographical region.
- Targeted strategies may be needed to address sex-specific challenges in CHD risk factor management across different regions.
Objective:
To investigate whether there are sex differences in risk factor management of patients with established coronary heart disease (CHD), and to assess demographic variations of any potential sex differences.
Methods:
Patients with CHD were recruited from Europe, Asia, and the Middle East between 2012-2013. Adherence to guideline-recommended treatment and lifestyle targets was assessed and summarised as a Cardiovascular Health Index Score (CHIS). Age-adjusted regression models were used to estimate odds ratios for women versus men in risk factor management.
Results:
10 112 patients (29% women) were included. Compared with men, women were less likely to achieve targets for total cholesterol (OR 0.50, 95% CI 0.43 to 0.59), low-density lipoprotein cholesterol (OR 0.57, 95% CI 0.51 to 0.64), and glucose (OR 0.78, 95% CI 0.70 to 0.87), or to be physically active (OR 0.74, 95% CI 0.68 to 0.81) or non-obese (OR 0.82, 95% CI 0.74 to 0.90). In contrast, women had better control of blood pressure (OR 1.31, 95% CI 1.20 to 1.44) and were more likely to be a non-smoker (OR 1.93, 95% CI 1.67 to 2.22) than men. Overall, women were less likely than men to achieve all treatment targets (OR 0.75, 95% CI 0.60 to 0.93) or obtain an adequate CHIS (OR 0.81, 95% CI 0.73 to 0.91), but no significant differences were found for all lifestyle targets (OR 0.93, 95% CI 0.84 to 1.02). Sex disparities in reaching treatment targets were smaller in Europe than in Asia and the Middle East. Women in Asia were more likely than men to reach lifestyle targets, with opposing results in Europe and the Middle East.
Conclusions:
Risk factor management for the secondary prevention of CHD was generally worse in women than in men. The magnitude and direction of the sex differences varied by region.