3121 — Higher LDL Levels in Women Compared to Men Despite Similar Treatment with Statins
Vimalananda VG, and Miller DR, COE-Bedford; Hofer TP, Holleman R, Klamerus ML, Hogan MM, and Kerr EA, COE-Ann Arbor;
Among those with diabetes, women are less likely than men to meet the dichotomous threshold measures for low-density lipoprotein (LDL) control (LDL <100mg/dL). We examined whether the gender disparity in the quality of lipid management persists when measured by appropriate clinical action.
Using data from the VA Corporate Data Warehouse, we examined the proportions of women and men aged 50-75 with diabetes who met each of three quality measures: LDL <100mg/dL; use of at least moderate dose statin; and a linked clinical action measure for lipid management, developed previously. The linked measure was defined as EITHER: 1) LDL <100mg/dL; OR 2) no LDL and on at least a moderate dose statin; OR 3) LDL >=100mg/dL and appropriate clinical action within 90 days of test. Appropriate clinical action was defined as use of at least a moderate dose statin at the time of LDL; increase in statin dose; start or change of a statin; or a repeat LDL <100mg/dL. We examined whether the disparity in management persisted when controlling for age, care in community-based clinic vs. medical center, number of PCP visits, and presence of ischemic heart disease (IHD), using two-level logistic regression models. We examined the interactions between gender and both age and IHD.
18,052 women and 583,855 men with diabetes and a primary care visit between July 1, 2009 and June 30, 2010 were included. Women were much less likely to have LDL <100mg/dL than were men (52% vs. 65%, p <0.001). However, women and men were similarly likely to be on at least a moderate dose statin (47% vs. 51%, p <0.001) and to have other clinical action (3.6% vs. 2.2%). Overall, the disparity in dyslipidemia management narrowed from 13% to 7% when appropriate treatment was taken into account through the clinical action measure. Controlling for multiple covariates did not affect risk estimates. There were no interactions with gender and either age or IHD.
The gender disparity in lipid management persists when applying a linked clinical action measure, but much of the disparity is related to achievement of LDL threshold levels rather than differences in appropriate clinical action.
Women with diabetes have higher LDL levels than do men despite similar treatment with statins. The reasons for this are unknown, but may include gender differences in medication adherence or tolerance. A focus on appropriate treatment, rather than meeting arbitrary thresholds, should improve care for both men and women.