Women with T2D Less Likely to Receive Guideline-recommended Cardiovascular Care vs Men

Women with type 2 diabetes with or without previous cardiovascular disease (CVD) are less likely than men to achieve treatment targets recommended for CVD risk management, according to results of an international study being presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), held online September 27 – October 3, 2021.

The study, which included nearly 10 000 persons with T2D, found that women were less likely to receive cardioprotective treatments, including statins, aspirin, and antihypertensive medications, all of which are guideline-recommended for individuals with T2D.

“Despite evidence of the 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 are not reaching recommended treatment targets”, said lead author Giulia Ferrannini, MD, from the Karolinska Institutet, Stockholm, Sweden, in a press statement. Ferrannini noted that while CVD is currently the leading cause of death among women, resources for prevention and treatment have never been better. “The reasons why women are not receiving the same standard of treatment as men are complex,” she added, “and require further investigation so that women with type 2 diabetes can be treated more effectively.”

To learn more about these gender disparities in CVD risk factor management Ferrannini and colleagues analyzed data from a subset of participants from the REWIND trial.

REWIND was an international, multicenter, randomized, placebo-controlled trial in 24 countries involving adults with T2D and a range of CV risk cardiovascular risk. The trial was designed to compare the efficacy of the GLP-1 receptor agonist dulaglutide against placebo on a primary composite outcome of nonfatal myocardial infarction (MI), nonfatal stroke, or CV death. After mean follow-up of 5.4 years, REWIND results showed that dulaglutide was associated with a 12% lower risk of the primary composite outcome (hazard ratio [HR], 0.88 [95% CI, 0.79-0.99]; P=.026).

Investigators analyzed gender differences in baseline characteristics, cardioprotective therapies used at baseline and at 2 years, relevant treatment targets reached, and observed CV outcomes.

Among the 9901 participants included in the substudy analysis, 46.3% were women. At study baseline, men were more likely than women to have a history of CVD (41.4% vs 20.0%; P <.001). Analyses found that the majority of women met clinically relevant treatment targets for blood pressure and cholesterol at baseline, but a smaller proportion of women were at target for ACE/ARB use (80% vs 83%), lipid control or statin use (73% vs 81%), or aspirin use (P <.001 for all).Over 2 years of follow-up, women remained less likely than men to achieve LDL cholesterol treatment goals, regardless of whether they had previously had a cardiovascular event, according to the press statement.

Overall, women were found to have a lower risk of all CV outcomes explored except for fatal or nonfatal stroke, a finding, authors point out, that was also observed in the subgroup of participants without a history of CVD at baseline.

Ferrannini et al also observed that among women with a history of CVD, risk of stroke, heart failure hospitalization, all-cause mortality, and CV mortality was similar to their male counterparts.

Ferrannini suggested that the lower risk for future CV events among women vs men, notwithstanding the use of fewer cardioprotective medications for women, could potentially be the result of gender differences in CVD pathophysiology.

She added, “It is important to consider all gender disparities that exist in the real-world setting that prevent women with diabetes to keep such [an] advantage including time to diagnosis, use of invasive revascularization procedures, and use of guideline-recommended treatments. Women with type 2 diabetes are at high cardiovascular risk and should not be neglected in its comprehensive management.”

Source: Ferannini G, Maldonao JM, Raha S, et al. Gender differences in cardiovascular risk, treatment, and outcomes: a post-hoc analysis from the REWIND trial. Abstract presented at: Annual Meeting of the European Association for the Study of Diabetes; held online September 37-October 3, 2021.