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. 2017 Oct;103(20):1587-1594.
doi: 10.1136/heartjnl-2017-311429. Epub 2017 Sep 20.

Sex differences in risk factor management of coronary heart disease across three regions

Min Zhao  1 , Ilonca Vaartjes  2   3 , Ian Graham  4 , Diederick Grobbee  1   3 , Wilko Spiering  5 , Kerstin Klipstein-Grobusch  1   6 , Mark Woodward  7   8 , Sanne Ae Peters  7
Affiliations

Sex differences in risk factor management of coronary heart disease across three regions

Min Zhao et al. Heart. 2017 Oct.

Abstract

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.

Keywords: coronary heart disease; risk factors; secondary prevention; sex differences.

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Conflict of interest statement

Competing interests: MW is a consultant to Amgen on analyses of Medicare data in the USA. Amgen had no input to the design, execution, analysis, or writing up of the study

Figures

Figure 1
Figure 1
Age-adjusted sex differences in risk factor management.  Target blood pressure (BP) was defined as BP <140/90 mmHg in those without diabetes or <140/80 mmHg in those with diabetes. The target for total cholesterol (TC), low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol levels were defined as <3 mmol/L, <1.8 mmol/L, and >1.0 mmol/L for men and >1.2 mmol/L for women, respectively. Target glucose was defined as <7 mmol/L. Information on glycated haemoglobin (HbA1c) was only collected from patients with diabetes and its target was defined as <7%. Achieving all three medical targets (BP on target, LDL on target, and glucose/HbA1c on target) was defined as ‘All treatment targets’. Obesity was defined as a body mass index (BMI) ≥30 kg/m2 and central obesity was defined as waist circumference ≥88 cm for women and ≥102 cm for men. Smoking status was current smoker and non-smoker. Adequate physical activity level was defined as moderate or vigorous physical activity for at least 30 min three or more times a week. Reaching all three lifestyle targets (non-smoker, adequate physical activities, and non-obesity) was defined as ‘All lifestyle targets’. Odds ratios (95% CI) presented as women versus men.
Figure 2
Figure 2
Age-adjusted sex differences in Cardiovascular Health Index Score (CHIS). The CHIS included six risk factors: smoking status (current smoker or non-smoker), body mass index (obese or not), physical activity (adequate or not), blood pressure (on target or not), low-density lipoprotein (LDL) cholesterol (on target or not), and HbA1c/glucose (on target or not). The number of controlled risk factors was summed, ranging from 0 to 6. A good CHIS was defined as five or more risk factors controlled (CHIS=5 or 6). Odds ratios (95% CI) presented as women versus men; p values are for interaction between subgroups.
Figure 3
Figure 3
Age-adjusted sex differences on treatment targets and lifestyle factor management, stratified by region. Conventions as in figure 1. Odds ratios (95% CI) presented as women versus men; p values are for interaction between subgroups.
Figure 4
Figure 4
Sex differences in treatment targets and lifestyle factor management, stratified by age. Conventions as in figure 1. Odds ratios (95% CI) presented as women versus men; p values are for interaction between subgroups.
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