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Original research article
Sex differences in risk factor management of coronary heart disease across three regions
  1. Min Zhao1,
  2. Ilonca Vaartjes2,3,
  3. Ian Graham4,
  4. Diederick Grobbee1,3,
  5. Wilko Spiering5,
  6. Kerstin Klipstein-Grobusch1,6,
  7. Mark Woodward7,8,
  8. Sanne AE Peters7
  1. 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3 Global Geo and Health Data Center, Utrecht University, Utrecht, The Netherlands
  4. 4 Trinity College Dublin, Dublin, Ireland
  5. 5 Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
  6. 6 Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  7. 7 The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
  8. 8 The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
  1. Correspondence to Min Zhao, Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; m.zhao{at}umcutrecht.nl, minzhao0208{at}gmail.com

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.

  • coronary heart disease
  • sex differences
  • secondary prevention
  • risk factors

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors MZ, SP, MW, KK, IV, RG, and IG conceived and designed the study. MZ, SP, and MW analyzed and interpreted the data. MZ drafted the manuscript and all authors contributed to critical revision of the manuscript.

  • Funding MZ is supported by a grant from the Netherlands Organization for Scientific Research (NWO; grant number: 0.22.005.021). NWO had no input to the design, execution, analysis, or writing up of the study. IV is supported by a grant from the Dutch Heart Foundation (grant DHF project ‘Facts and Figures’). MW is supported by the National Health and Medical Research Foundation of Australia (1080206). SP is supported by the British Heart Foundation (PG/16/57/32256)

  • 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

  • Provenance and peer review Not commissioned; externally peer reviewed.

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