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Circulation. 2019 Jun 11;139(24):2742-2753. doi: 10.1161/CIRCULATIONAHA.118.039100. Epub 2019 Apr 15.

Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes Mellitus.

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Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre (A.K.W., D.M.A.).
Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences (A.K.W., M.K.R.).
Division of Population Health, Health Services, & Primary Care, School of Health Sciences, (E.K.).
Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK (R.E.).
Health eResearch Center, Farr Institute, Division of Informatics, Imaging & Data Sciences, School of Health Sciences (I.B.), University of Manchester.
Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, UK (I.B.).
Keele Cardiovascular Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK (M.A.M.).
Institute of Cardiovascular & Medical Sciences, University of Glasgow, UK (N.S.).
Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre (M.K.R.), UK.



With recent changes in the United Kingdom's clinical practice for diabetes mellitus care, contemporary estimates of sex disparities in cardiovascular risk and risk factor management are needed.


In this retrospective cohort study, using the Clinical Practice Research Datalink linked to hospital and death records for people in England, we identified 79 985 patients with incident type 2 diabetes mellitus (T2DM) between 2006 to 2013 matched to 386 547 patients without diabetes mellitus. Sex-stratified Cox models were used to assess cardiovascular risk.


Compared with women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted hazard ratio, 1.20 [95% confidence interval, 1.12-1.28]) with similar corresponding data in men (hazard ratio, 1.12 [1.06-1.19]), leading to a nonsignificant higher relative risk in women (risk ratio, 1.07 [0.98-1.17]). However, some important sex differences in the management of risk factors were observed. Compared with men with T2DM, women with T2DM were more likely to be obese, hypertensive, and have hypercholesterolemia, but were less likely to be prescribed lipid-lowering medication and angiotensin-converting enzyme inhibitors, especially if they had cardiovascular disease.


Compared with men developing T2DM, women with T2DM do not have a significantly higher relative increase in cardiovascular risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes mellitus care in women and men.


cardiovascular diseases; database; diabetes mellitus, type 2; primary health care; risk factors

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