What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Primary prevention of cardiovascular diseases (n=83903). Intervention: Female sex vs. Male sex. Primary outcome: Prescription of lipid-lowering medications among individuals with elevated LDL-c levels (RR 0.87, 95% CI 0.79-0.95).

January 19, 2024Open Access

Sex Differences in the Primary Prevention of Cardiovascular Diseases in a Dutch Primary Care Setting

Key Result

Women with elevated cholesterol levels were significantly less likely than men to be prescribed lipid-lowering medications (RR 0.87) and, when treated, were less likely to meet target cholesterol levels.

Study Design

Type

Cross-Sectional (n=83,903)

Multicenter

Yes

Structured PICO

Are there sex differences in cardiovascular risk factor assessment, levels, treatment, and control in primary care?

Population

83,903 adults aged 40 to 70 years without prior cardiovascular disease, registered at Dutch general practices in 2018, assessed for sex differences in cardiovascular risk management.

Comparator

Men vs. Women

Outcome

Sex differences in cardiovascular risk factor assessment, risk factor levels, treatment, and meeting of treatment targets

In primary care, women are more likely to have cardiovascular risk factors assessed but are less likely to receive lipid-lowering therapy or reach LDL targets, whereas men are less likely to achieve blood pressure control.

Main Result

Relative Risk: 0.87 (95% CI 0.79–0.95)

Absolute Event Rate: 17% vs 19%

Limitations

Quality of data depends on GP recording accuracy, with potential for misclassification and data entry errors
Potential informative missingness of risk factor measurements
Only captures primary care data, missing medications prescribed in secondary and tertiary care
Smoking was not well documented, precluding the calculation of a CVD risk score
Eligibility for treatment was based on the value of a single measurement rather than a comprehensive approach
No data available on lifestyle risk factors such as diet and sedentary lifestyle, or ethnicity
Medication data was based on prescribed rather than dispensed medications

Abstract

Background: Sex differences in the primary prevention of cardiovascular diseases (CVD) have been shown, but the evidence is mixed and fragmented. In this study, we assessed sex differences in cardiovascular risk factors assessment, risk factor levels, treatment, and meeting of treatment targets, within a Dutch primary care setting. Methods: Data were obtained from individuals aged 40 to 70 years old, without prior CVD, registered during the entire year in 2018 at one of the 51 general practices participating in the Julius General Practitioner's Network (JGPN). History of CVD was defined based on the International Classification of Primary Care (ICPC). Linear and Poisson regressions were used to investigate sex differences in risk factor assessment, risk factor levels, treatment, and meeting of treatment targets. Results: We included 83,903 individuals (50% women). With the exception of glycated hemoglobin (HbA1c), all risk factors for CVD were more often measured in women than in men. Lipid measurements and body mass index values were higher in women, while blood pressure (BP) and HbA1c levels were higher in men, along with estimated glomerular filtration rate (eGFR) levels. Among individuals with elevated BP or cholesterol levels, no sex difference was observed in the prescription of antihypertensive medications (RR 1.00, 95% CI: 0.94-1.06) but women were less likely than men to receive lipid-lowering medications (RR 0.87, 95% CI: 0.79-0.95). Among treated individuals, women were more likely than men to meet adequate levels of blood pressure (RR 1.17, 95% CI: 1.09-1.25) and less likely to meet target levels of cholesterol (RR 0.90, 95% CI: 0.83-0.98). Conclusion: While women were more likely to have their CVD risk factors measured, they were less likely to be prescribed lipid-lowering medications and to meet target levels. When treated, men were less likely to achieve adequate blood pressure control.

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