Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes: A Population-Based Cohort Study Assessing Sex Disparities

Alison K Wright; Evangelos Kontopantelis; Richard Emsley; Iain Edward Buchan; Mamas A Mamas; Naveed Sattar; Darren M Ashcroft; Martin K Rutter

doi:10.1161/CIRCULATIONAHA.118.039100

Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes: A Population-Based Cohort Study Assessing Sex Disparities

Alison K Wright, Evangelos Kontopantelis, Richard Emsley, Iain Edward Buchan, Mamas A Mamas, Naveed Sattar, Darren M Ashcroft, Martin K Rutter

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Abstract

BACKGROUND: With recent changes in UK clinical practice for diabetes care, contemporary estimates of sex disparities in cardiovascular risk and risk factor management are needed.

METHODS: In this retrospective cohort study, using the Clinical Practice Research Datalink linked to hospital and death records for people in England, we identified 79,985 patients with incident T2DM between 2006-2013 matched to 386,547 patients without diabetes. Sex-stratified Cox models were used to assess cardiovascular risk.

RESULTS: Compared to women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted HR 1.20 [95% CI 1.12-1.28]) with similar corresponding data in men (HR 1.12 [1.06-1.19]) leading to a non-significant higher relative risk in women (risk ratio 1.07 [0.98-1.17]). However, some important sex differences in the management of risk factors were observed. Compared to men with T2DM, women with T2DM were more likely to be obese, hypertensive and have hypercholesterolaemia but were less likely to be prescribed lipid-lowering medication and ACE inhibitors, especially if they had CVD.

CONCLUSIONS: Compared to men developing T2DM, women with T2DM do not have a significantly higher relative increase in cardiovascular risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes care in women and men.

Original language	English
Pages (from-to)	2742–2753
Journal	Circulation
Volume	139
Issue number	24
Early online date	15 Apr 2019
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.118.039100
Publication status	Published - 15 Apr 2019

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title = "Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes: A Population-Based Cohort Study Assessing Sex Disparities",

abstract = "BACKGROUND: With recent changes in UK clinical practice for diabetes care, contemporary estimates of sex disparities in cardiovascular risk and risk factor management are needed.METHODS: In this retrospective cohort study, using the Clinical Practice Research Datalink linked to hospital and death records for people in England, we identified 79,985 patients with incident T2DM between 2006-2013 matched to 386,547 patients without diabetes. Sex-stratified Cox models were used to assess cardiovascular risk.RESULTS: Compared to women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted HR 1.20 [95% CI 1.12-1.28]) with similar corresponding data in men (HR 1.12 [1.06-1.19]) leading to a non-significant higher relative risk in women (risk ratio 1.07 [0.98-1.17]). However, some important sex differences in the management of risk factors were observed. Compared to men with T2DM, women with T2DM were more likely to be obese, hypertensive and have hypercholesterolaemia but were less likely to be prescribed lipid-lowering medication and ACE inhibitors, especially if they had CVD.CONCLUSIONS: Compared to men developing T2DM, women with T2DM do not have a significantly higher relative increase in cardiovascular risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes care in women and men.",

author = "Wright, {Alison K} and Evangelos Kontopantelis and Richard Emsley and Buchan, {Iain Edward} and Mamas, {Mamas A} and Naveed Sattar and Ashcroft, {Darren M} and Rutter, {Martin K}",

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T1 - Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes

T2 - A Population-Based Cohort Study Assessing Sex Disparities

AU - Wright, Alison K

AU - Kontopantelis, Evangelos

AU - Emsley, Richard

AU - Buchan, Iain Edward

AU - Mamas, Mamas A

AU - Sattar, Naveed

AU - Ashcroft, Darren M

AU - Rutter, Martin K

PY - 2019/4/15

Y1 - 2019/4/15

N2 - BACKGROUND: With recent changes in UK clinical practice for diabetes care, contemporary estimates of sex disparities in cardiovascular risk and risk factor management are needed.METHODS: In this retrospective cohort study, using the Clinical Practice Research Datalink linked to hospital and death records for people in England, we identified 79,985 patients with incident T2DM between 2006-2013 matched to 386,547 patients without diabetes. Sex-stratified Cox models were used to assess cardiovascular risk.RESULTS: Compared to women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted HR 1.20 [95% CI 1.12-1.28]) with similar corresponding data in men (HR 1.12 [1.06-1.19]) leading to a non-significant higher relative risk in women (risk ratio 1.07 [0.98-1.17]). However, some important sex differences in the management of risk factors were observed. Compared to men with T2DM, women with T2DM were more likely to be obese, hypertensive and have hypercholesterolaemia but were less likely to be prescribed lipid-lowering medication and ACE inhibitors, especially if they had CVD.CONCLUSIONS: Compared to men developing T2DM, women with T2DM do not have a significantly higher relative increase in cardiovascular risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes care in women and men.

AB - BACKGROUND: With recent changes in UK clinical practice for diabetes care, contemporary estimates of sex disparities in cardiovascular risk and risk factor management are needed.METHODS: In this retrospective cohort study, using the Clinical Practice Research Datalink linked to hospital and death records for people in England, we identified 79,985 patients with incident T2DM between 2006-2013 matched to 386,547 patients without diabetes. Sex-stratified Cox models were used to assess cardiovascular risk.RESULTS: Compared to women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted HR 1.20 [95% CI 1.12-1.28]) with similar corresponding data in men (HR 1.12 [1.06-1.19]) leading to a non-significant higher relative risk in women (risk ratio 1.07 [0.98-1.17]). However, some important sex differences in the management of risk factors were observed. Compared to men with T2DM, women with T2DM were more likely to be obese, hypertensive and have hypercholesterolaemia but were less likely to be prescribed lipid-lowering medication and ACE inhibitors, especially if they had CVD.CONCLUSIONS: Compared to men developing T2DM, women with T2DM do not have a significantly higher relative increase in cardiovascular risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes care in women and men.

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DO - 10.1161/CIRCULATIONAHA.118.039100

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Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes: A Population-Based Cohort Study Assessing Sex Disparities

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