Women Veterans, Particularly Black Veterans, Have Worse Risk Factor Control for Cardiovascular Disease than Male Veterans
Over the last few decades, efforts to treat risk factors along with the increased use of effective medical therapies have led to measurable reductions in overall deaths from cardiovascular disease (CVD) among both men and women. However, these reductions have stagnated in recent years, and CVD-related deaths are rising in women aged 35 to 44 years. In addition to gender disparities in CVD morbidity and mortality, there is evidence of racial/ethnic group disparities. This study compared gender and racial differences in three risk factors that predispose individuals to CVD: diabetes, hypertension, and hyperlipidemia. Investigators identified 23,955 male Veterans and 1,010 female Veterans in 2011 who lived in North Carolina or Virginia, were 40 years of age or older, and were enrolled in one of three primary care clinics affiliated with the Durham VAMC. Veterans in this study also had at least one primary care visit in the past year, and had an outpatient diagnosis of hypertension and/or hyperlipidemia. Using VA data, investigators assessed patients' outpatient LDL cholesterol levels (includes both fasting and non-fasting), HbA1c, and blood pressure. They also examined demographics, and used the following racial categories: White, African-American, and other (i.e., American Indian, Asian, Pacific Islander, Hispanic, and unknown).
- Overall, female Veterans had significantly higher LDL cholesterol levels than male Veterans (111.7 and 97.6 mg/dL, respectively), despite being almost ten years younger, on average. These differences are similar to gender disparities previously reported both within and outside VHA and represent a clinically significant difference. There was no difference in LDL levels between African-American and White women; however, LDL levels were greater among African-American men than White men (99.6 vs. 95.8 mg/dL), which is unlikely to represent a significant clinical difference.
- African-American women Veterans had worse blood pressure control than White women Veterans with mean systolic blood pressures of 136.3mmHg vs 133.5mmHg and diastolic blood pressures of 82.4mmHg vs. 78.9mmHg.
- Among Veterans with diabetes, male African-Americans had worse control of higher blood pressure (135.7/78.5 mmHg vs 132.6/74.9 mmHg), LDL (90.3 vs 85.7 ml/dL), and HbA1c (7.5% vs 7.3%) levels than White males.
- The racial disparities analysis was based on medical record data, which may contain inaccuracies.
- This study did not include other CVD risk factors, e.g., smoking status or family history.
- The number of women included in this study is relatively small.
- Further exploration of racial differences in gender disparities among the Veteran population could help identify contributing factors and highlight areas of importance for future interventions.
Goldstein K, Melnyk S, Zullig L, Stechuchak K, Oddone E, Bastian L, Rakley S, Olsen M, and Bosworth H. Heart Matters: Gender and Racial Differences Cardiovascular Disease Risk Factor Control among Veterans. Women’s Health Issues. September-October 2014;24(5):477-483.