Cardiovascular Care for Women with Diabetes Lagging Behind Care for Men

Giulia Ferrannini, MD

New research suggests women with type 2 diabetes are less likely to receive comprehensive cardiovascular prevention than their male counterparts.

Presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), results of the analysis indicate women were less likely to achieve treatment targets for cardiovascular management than their male counterparts and were less likely to receive guideline-directed medical therapies.

“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 statement. “Cardiovascular disease is the leading killer of women, but it has never been more preventable and treatable. The reasons why women are not receiving the same standard of treatment as men are complex and require further investigation so that women with type 2 diabetes can be treated more effectively.”

With improving the cardiovascular care of women, especially those with diabetes, a major research focus in the community, Ferrannini and colleagues from Karolinska Institute, Population Health Research Institute, and Eli Lilly and Company performed the current study with the intent of assessing the topic through analysis of the REWIND trial. To do so, the current study was designed as an assessment of a subset of REWIND participants with baseline and follow-up data related to blood pressure, LDL-C, and HDL-C from within the REWIND trial.

Briefly, the REWIND trial was a multicenter, randomized, placebo-controlled trial conducted in 24 countries and enrolling more nearly 10,000 patients with type 2 diabetes and various levels of cardiovascular risk. The trial had a mean follow-up of 5.4 years and was designed to compare the effects of dulaglutide against placebo therapy with a primary composite outcome of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. The trial ultimately concluded dulaglutide was associated with a 12% lower risk of the primary composite outcome (HR, 0.88 [95% CI, 0.79-0.99]; P=.026).

Of the 9901 patients within the REWIND trial, 46.3% were women. Of note, men included in the study were more likely to have a history of cardiovascular disease than their female counterparts (41.4% vs 20.0%; P <.001). Upon analysis, results indicate 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).

Further analysis suggested women had a lower risk for all cardiovascular outcomes included in the study except for fatal or nonfatal stroke, which investigators pointed out was also observed in a subgroup of patients without a history of cardiovascular disease at baseline. Additionally, investigators pointed out women with a history of cardiovascular disease had a similar risk of stroke, heart failure hospitalization, all-cause mortality, and cardiovascular mortality compared to their male counterparts.

“It is important to consider all gender disparities that exist in the real-world setting that prevent women with diabetes to keep such 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,” Ferrannini added.

This study, “Gender differences in cardiovascular risk, treatment, and outcomes: a post-hoc analysis from the REWIND trial,” was presented at EASD 2021.