Among Patients with Type 1 Diabetes, Woman May Be Less Likely Than Men to Receive Cardioprotective Medication for Cardiovascular Disease

New research from the Diabetes Control and Complications/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) studies suggest that women with type 1 diabetes may have a similar or increased risk of cardiovascular disease (CVD) than men, despite having lower cardiometabolic risk factors overall.

Cardioprotective medications were used in approximately 11% more men than women and lipid-lowering medication was used in 14% more men than women.

“Women were [still] less likely to receive standard cardioprotective medications, despite emerging evidence since 2010 regarding increased CVD risk in women,” the researchers wrote in the report, which was published in JAMA Open Network.

Women have a lower absolute risk of CVD than men; however, women with type 1 or type 2 diabetes are suggested to have a similar or increased risk of CVD compared to men. Although biology may account for this difference, other reasons could be unequal access to effective treatments or risk factor management that could decrease the risk of CVD, according to the study authors.

Researchers wanted to compare the risk of CVD between men vs women with type 1 diabetes based on cardiometabolic risk factors, cardioprotective therapies, or reaching target levels.

They used 1441 participants with type 1 diabetes from the DCCT trial (1983 to 1993) and the EDIC trial (1994 until today).

The team randomized patients to receive intensive or conventional diabetes therapy. With a mean follow-up of 6.5 years, the researchers analyzed the development of diabetes-related complications from glycemia, such as CVD.

The results suggest that women with type 1 and type 2 diabetes had a lower body mass index (BMI), waist circumference, blood pressure (BP), and triglyceride levels than men with diabetes. Females also had higher levels of high-density lipoprotein cholesterol than men, but similar low-density lipoprotein levels. Further, there was less hypertension and kidney disease reported in female participants.

However, women still had statistically similar CVD rates as men, despite research suggesting that “achieving treatment targets for BP, lipids, and glucose was associated with significantly decreased risk of CVD in both women and men, a finding that underscores the need for optimal control of comorbid risk factors in all individuals with diabetes,” the study authors wrote in the report.

The study was limited demographically because it looked at a primarily non-Hispanic White cohort. Additionally, other medications (aside from insulin) were not accounted for by DCCT/EDIC investigators. And the researchers could not administer cardioprotective prescriptions, limiting the findings.

“These findings suggest that despite a more favorable cardiometabolic risk factor profile, women with type 1 diabetes did not have a significantly lower CVD event burden than men, suggesting a greater clinical impact of cardiometabolic risk factors in women vs men with diabetes,” the study authors wrote in the report. “These findings call for conscientious optimization of the control of CVD risk factors in women with type 1 diabetes.”

Reference

Braffett, Barbara, Bebu, Ionut, El ghormli, Laure, et al. Cardiometabolic Risk Factors and Incident Cardiovascular Disease Events in Women vs Men With Type 1 Diabetes. JAMA Netw Open. 2022;5(9):e2230710. doi:10.1001/jamanetworkopen.2022.30710