Billimek John, Malik Shaista, Sorkin Dara H, Schmalbach Priel, Ngo-Metzger Quyen, Greenfield Sheldon, Kaplan Sherrie H
Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California.
Division of Cardiology, Department of Medicine, School of Medicine, University of California, Irvine, California.
Womens Health Issues. 2015 Jan-Feb;25(1):6-12. doi: 10.1016/j.whi.2014.09.004. Epub 2014 Nov 22.
Gender differences in dyslipidemia are widely documented, but the contributors to these differences are not well understood. This study examines whether differences in quality of care, intensity of lipid-lowering medication regimen, and medication adherence can explain this disparity.
Secondary analysis of medical records data and questionnaires collected from adult patients with type 2 diabetes (n = 1,369) from seven outpatient clinics affiliated with an academic medical center as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. Primary outcome was low-density lipoprotein (LDL) cholesterol.
Women had higher LDL cholesterol levels than men (mean [SD], 101.2 [35.2] vs. 92.3 [33.0] mg/dL; p < .001), but were no less likely to receive recommended processes of diabetes care, to attain targets for glycemic control and blood pressure, or to be on intensive medication regimens. More women than men reported medication nonadherence related to cost (32.7% vs. 24.2%; p = .040) and related to side effects (47.2% vs. 36.8%; p = .024). For all patients, regimen intensity (p < .05) and nonadherence related to side effects (p < .01) were each associated with higher LDL cholesterol levels. The addition of a new lipid-lowering agent was associated with subsequent nonadherence related to side effects for women (p < .001), but not for men (p = .45; test for interaction p = .048).
Despite comparable quality of diabetes care and regimen intensity for lipid management, women with diabetes experienced poorer lipid control than men. Medication nonadherence seemed to be a major contributor to dyslipidemia, particularly for women because of side effects associated with intensifying the lipid-lowering regimen.
血脂异常的性别差异已有广泛记载，但造成这些差异的因素尚不清楚。本研究探讨医疗服务质量、降脂药物治疗方案强度及药物依从性的差异是否能解释这种差异。
对来自一所学术医疗中心下属七家门诊的2型糖尿病成年患者（n = 1369）收集的病历数据和问卷进行二次分析，该研究是“减少糖尿病种族差异：指导护理（R2D2C2）”研究的一部分。主要结局指标为低密度脂蛋白（LDL）胆固醇。
女性的LDL胆固醇水平高于男性（均值[标准差]，101.2[35.2] vs. 92.3[33.0]mg/dL；p <.001），但接受推荐的糖尿病护理流程、实现血糖控制和血压目标或采用强化药物治疗方案的可能性并不低于男性。报告因费用导致药物不依从的女性多于男性（32.7% vs. 24.2%；p = 0.040），因副作用导致药物不依从的女性也多于男性（47.2% vs. 36.8%；p = 0.024）。对于所有患者，治疗方案强度（p <.05）和因副作用导致的不依从（p <.01）均与较高的LDL胆固醇水平相关。添加新的降脂药物与女性随后因副作用导致的不依从相关（p <.001），但与男性无关（p = 0.45；交互作用检验p = 0.048）。
尽管糖尿病护理质量和血脂管理的治疗方案强度相当，但糖尿病女性的血脂控制比男性差。药物不依从似乎是血脂异常的主要原因，尤其是对女性而言，这是由于强化降脂治疗方案带来的副作用。
