基层医疗中糖尿病患者心血管风险管理的性别差异：一项横断面研究。
Sex differences in cardiovascular risk management for people with diabetes in primary care: a cross-sectional study.
作者信息
de Jong Marit, Vos Rimke C, de Ritter Rianneke, van der Kallen Carla J, Sep Simone J, Woodward Mark, Stehouwer Coen DA, Bots Michiel L, Peters Sanne Ae
机构信息
PhD Student, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Assistant Professor, Department of Public Health and Primary Care / LUMC-Campus, Leiden University Medical Center, The Hague, The Netherlands.
出版信息
BJGP Open. 2019 Jul 23;3(2). doi: 10.3399/bjgpopen19X101645. Print 2019 Jul.
BACKGROUND
Diabetes is a stronger risk factor for cardiovascular complications in women than men.
AIM
To evaluate whether there are sex differences in cardiovascular risk management in patients with diabetes in primary care.
DESIGN & SETTING: A cross-sectional study was undertaken using data from 12 512 individuals with diabetes within the Dutch Julius General Practitioners Network (JGPN) from 2013.
METHOD
Linear and Poisson regression analyses were used to assess sex differences in risk factor levels, assessment, treatment, and control.
RESULTS
No sex differences were found in HbA1c levels and control, while small differences were found for cardiovascular risk management. Blood pressure levels were higher (mean difference [MD] 1.09 mmHg; 95% confidence intervals [CI] = 0.41 to 1.77), while cholesterol levels (MD -0.38 mmol/l; 95% CI = -0.42 to -0.34) and body mass index ([BMI] MD -1.79 kg/m; 95% CI = -2.03 to 1.56) were lower in men than women. Risk factor assessment was similar between sexes, apart from high-density lipoprotein cholesterol (HDL-c), which was more commonly assessed in women (risk ratio [RR] 1.16; 95% CI = 1.13 to 1.20). Among those with a treatment indication for prevention, women with cardiovascular disease (CVD) were less likely to receive lipid-lowering drugs (RR 0.84; 95% CI = 0.76 to 0.93) than men, while women without CVD were more likely to receive lipid-lowering drugs (RR 1.16; 95% CI = 1.04 to 1.2). Among those treated, women were more likely to achieve systolic blood pressure (SBP) control (RR 1.06; 95% CI = 1.02 to 1.10) and less likely to achieve low-density lipoprotein cholesterol (LDL-c) control (RR 0.88; 95% CI = 0.85 to 0.91) than men.
CONCLUSION
In this Dutch primary care setting, sex differences in risk factor assessment and treatment of people with diabetes were small. However, women with diabetes were less likely to achieve control for LDL-c and more likely to achieve blood pressure control than men with diabetes.
背景
糖尿病对女性心血管并发症而言是比男性更强的风险因素。
目的
评估初级保健中糖尿病患者的心血管风险管理是否存在性别差异。
设计与设置
一项横断面研究，使用了荷兰朱利叶斯全科医生网络（JGPN）2013年以来12512名糖尿病患者的数据。
方法
采用线性回归和泊松回归分析来评估风险因素水平、评估、治疗和控制方面的性别差异。
结果
糖化血红蛋白（HbA1c）水平及控制情况未发现性别差异，而在心血管风险管理方面发现了细微差异。男性的血压水平更高（平均差[MD]1.09mmHg；95%置信区间[CI]=0.41至1.77），而胆固醇水平（MD -0.38mmol/L；95%CI=-0.42至-0.34）和体重指数（[BMI]MD -1.79kg/m²；95%CI=-2.03至-1.56）低于女性。除高密度脂蛋白胆固醇（HDL-c）外，性别之间的风险因素评估相似，HDL-c在女性中更常被评估（风险比[RR]1.16；95%CI=1.13至1.2）。在有预防治疗指征的人群中，患有心血管疾病（CVD）的女性比男性接受降脂药物治疗的可能性更小（RR 0.84；95%CI=0.76至0.93），而无CVD的女性接受降脂药物治疗的可能性更大（RR 1.16；95%CI=1.04至1.2）。在接受治疗的人群中，女性比男性更有可能实现收缩压（SBP）控制（RR 1.06；95%CI=1.02至1.1），而实现低密度脂蛋白胆固醇（LDL-c）控制的可能性更小（RR 0.88；95%CI=0.85至0.91）。
结论
在荷兰的这一初级保健环境中，糖尿病患者的风险因素评估和治疗方面的性别差异较小。然而，糖尿病女性比糖尿病男性更不容易实现LDL-c控制，而更有可能实现血压控制。
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