Sex differences in cardiovascular risk, lifestyle, and psychological factors in patients with type 2 diabetes: the Fukuoka Diabetes Registry

Abstract

Background: The excess risk of cardiovascular diseases associated with diabetes is greater in women than in men. The present study aimed to examine sex differences in the control of cardiovascular risk factors, as well as lifestyle and psychological factors, in patients with type 2 diabetes.

Methods: A total of 4923 Japanese patients with type 2 diabetes were included in this cross-sectional study. Female/male differences in cardiovascular risk factor levels, and corresponding odds ratios for achieving recommended ranges for preventing cardiovascular diseases and having unhealthy lifestyle and psychological factors were computed by linear and logistic regression models.

Results: Women were less likely than men to achieve recommended ranges for glycated hemoglobin, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and obesity-related anthropometric indices such as body mass index and waist circumference, but were more likely than men to be on target for high-density lipoprotein cholesterol and triglycerides. Women were also more likely than men to have an unhealthy lifestyle and psychological factors, including less dietary fiber intake, less leisure-time physical activity, shorter sleep duration, more constipation, and more depressive symptoms. Similar findings were observed when the participants were subgrouped by age (< 65 and ≥ 65 years) and past history of cardiovascular disease.

Conclusions: We observed significant sex differences for a range of cardiovascular risk factors, as well as lifestyle and psychological factors, suggesting the importance of adopting a sex-specific approach for the daily clinical management of diabetes.

Keywords: Cardiovascular risk factor; Diabetes; Lifestyle; Psychosocial factor; Sex difference.

Fig. 1

Cardiovascular risk factor levels in men and women. Mean values and female/male differences adjusted for age. Mean levels presented as mean (standard error). Triglycerides presented as geometric mean (95% CI), and differences calculated after log-transformation among participants with available data for fasting values (n: women = 1929, men = 2512). Six participants with missing values for defecation frequency were excluded from the analysis of constipation. BMI body mass index, BP blood pressure, CES-D Center for Epidemiologic Studies Depression, CI confidence interval, HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, LTPA leisure-time physical activity, TG triglycerides

Fig. 2

Achievement of recommended ranges for cardiovascular risk factors in men and women. *Female/male odds ratios adjusted for age. **LDL-C < 2.59 mmol/L in participants with a history of coronary heart disease, < 3.11 mmol/L in those without a history of coronary heart disease. ***Non-HDL-C < 3.37 mmol/L in participants with a history of coronary heart disease, < 3.89 mmol/L in those without a history of coronary heart disease. Triglycerides evaluated among participants with available data for fasting values (n: women = 1929, men = 2512). Six participants with missing values for defecation frequency were excluded from the analysis of constipation. BMI body mass index, BP blood pressure, CES-D Center for Epidemiologic Studies Depression, CI confidence interval, HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, LTPA leisure-time physical activity, TG triglycerides