2型糖尿病患者心血管危险因素综合控制中的性别差异。
Gender differences in composite control of cardiovascular risk factors among patients with type 2 diabetes.
作者信息
Strom Williams Joni L, Lynch Cheryl P, Winchester Rhonda, Thomas Leslie, Keith Brad, Egede Leonard E
机构信息
1 Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina , Charleston, South Carolina.
出版信息
Diabetes Technol Ther. 2014 Jul;16(7):421-7. doi: 10.1089/dia.2013.0329. Epub 2014 Apr 15.
OBJECTIVE
Disparities in outcomes for cardiovascular disease (CVD) exist between men and women with type 2 diabetes mellitus (T2DM). We examined gender differences in composite control of cardiovascular risk factors in a sample of adults with T2DM.
SUBJECTS AND METHODS
This was a cross-sectional study of 680 people recruited from three primary care settings. Primary outcomes were individual and composite control of CVD risk factors. Control of individual risk outcomes was defined as glycosylated hemoglobin A1c (HbA1c) level of <7%, blood pressure (BP) of <130/80 mm Hg, and low-density lipoprotein (LDL) cholesterol level of <100 mg/dL. Composite control was defined as having all three outcomes under control simultaneously. Linear and logistic regression models were used to assess differences in individual means and individual and composite outcomes control between men and women, while adjusting for relevant covariates.
RESULTS
Men made up 56% of the sample, approximately 67% were non-Hispanic black, and 78% made less than $35,000 annually. Unadjusted mean systolic BP (134 mm Hg vs. 130 mm Hg, P=0.005) and LDL cholesterol (99.7 mg/dL vs. 87.6 mg/dL, P<0.001) levels were significantly higher in women than in men. Adjusted linear regression showed mean diastolic BP (β=3.09; 95% confidence interval 0.56, 5.63) was significantly higher in women. Overall, 12.4% of the sample had composite control, and women had poorer composite control compared with men (5.9% vs. 17.3%). Adjusted logistic models showed that men were significantly more likely to have composite risk factor control (odds ratio 2.90; 95% confidence interval 1.37, 6.13) compared with women.
CONCLUSIONS
In this sample of adults with T2DM, women had significantly lower composite control compared with men, when adjusting for relevant confounders. It is imperative that women are informed about CVD risk factors, educated on how to reduce them, and aggressively treated to avoid adverse outcomes. Additional research involving women is needed to explore and reduce disparities in CVD risk between men and women with T2DM.
目的
2型糖尿病（T2DM）成年患者中，男性和女性的心血管疾病（CVD）结局存在差异。我们在一组T2DM成年样本中研究了心血管危险因素综合控制方面的性别差异。
受试者与方法
这是一项对从三个初级保健机构招募的680人进行的横断面研究。主要结局是CVD危险因素的个体控制和综合控制。个体危险因素控制定义为糖化血红蛋白A1c（HbA1c）水平<7%、血压（BP）<130/80 mmHg以及低密度脂蛋白（LDL）胆固醇水平<100 mg/dL。综合控制定义为同时控制所有三项指标。使用线性和逻辑回归模型评估男性和女性在个体均值以及个体和综合结局控制方面的差异，同时对相关协变量进行调整。
结果
男性占样本的56%，约67%为非西班牙裔黑人，78%的人年收入低于35,000美元。未调整时，女性的平均收缩压（134 mmHg对130 mmHg，P = 0.005）和LDL胆固醇（99.7 mg/dL对87.6 mg/dL，P<0.001）水平显著高于男性。调整后的线性回归显示女性的平均舒张压（β = 3.09；95%置信区间0.56，5.63）显著更高。总体而言，12.4%的样本实现了综合控制，女性的综合控制情况比男性差（分别为5.9%和17.3%）。调整后的逻辑模型显示，与女性相比，男性更有可能实现综合危险因素控制（优势比2.90；95%置信区间1.37，6.13）。
结论
在这个T2DM成年样本中，调整相关混杂因素后，女性的综合控制情况显著低于男性。必须让女性了解CVD危险因素，对她们进行如何降低这些危险因素的教育，并积极治疗以避免不良结局。需要开展更多涉及女性的研究来探索并减少T2DM男性和女性之间CVD风险的差异。
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