Zhao Min, Vaartjes Ilonca, Graham Ian, Grobbee Diederick, Spiering Wilko, Klipstein-Grobusch Kerstin, Woodward Mark, Peters Sanne Ae
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Heart. 2017 Oct;103(20):1587-1594. doi: 10.1136/heartjnl-2017-311429. Epub 2017 Sep 20.
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.
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.
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.
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.
探讨确诊冠心病（CHD）患者在危险因素管理方面是否存在性别差异，并评估任何潜在性别差异的人口统计学变化。
2012年至2013年期间，从欧洲、亚洲和中东地区招募冠心病患者。评估对指南推荐的治疗和生活方式目标的依从性，并汇总为心血管健康指数评分（CHIS）。使用年龄调整回归模型估计女性与男性在危险因素管理方面的比值比。
纳入10112例患者（29%为女性）。与男性相比，女性更难实现总胆固醇（比值比0.50，95%置信区间0.43至0.59）、低密度脂蛋白胆固醇（比值比0.57，95%置信区间0.51至0.64）和血糖（比值比0.78，95%置信区间0.70至0.87）的目标，或达到身体活动（比值比0.74，95%置信区间0.68至0.81）或非肥胖（比值比0.82，95%置信区间0.74至0.90）的标准。相比之下，女性在血压控制方面更好（比值比1.31，95%置信区间1.20至1.44），且比男性更有可能不吸烟（比值比1.93，95%置信区间1.67至2.22）。总体而言，女性比男性更难实现所有治疗目标（比值比0.75，95%置信区间0.60至0.93）或获得足够的CHIS（比值比0.81，95%置信区间0.73至0.91），但在所有生活方式目标方面未发现显著差异（比值比0.93，95%置信区间0.84至1.02）。在欧洲，实现治疗目标方面的性别差异小于亚洲和中东地区。亚洲女性比男性更有可能实现生活方式目标，而在欧洲和中东地区则结果相反。
冠心病二级预防的危险因素管理总体上女性比男性差。性别差异的程度和方向因地区而异。
