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Gender differences in cardiovascular disease risk management for Pacific Islanders in primary care

Gu Y, Warren J, Walker N, Kennelly J
 
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Abstract

Objectives To assess gender differences in cardiovascular disease risk (CVR) assessment and management for Pacific people in New Zealand. Methods New Zealand guidelines indicate CVR assessment from age 35 years for Pacific men and from age 45 years for Pacific women. Using general practice electronic medical records from 16 practices in New Zealand, the rate of CVR screening, treatment patterns and physiological measures for high-CVR ( 15% five-year) patients were assessed for Pacific patients  20 years of age by gender. Results Records for 10 863 Pacific patients showed a higher proportion of indicated women screened for CVR (65 vs 56%), but a lower proportion of assessed women with high CVR (28% for Pacific women vs 40% for Pacific men). Many of these high-CVR patients had physiological measures well above desirable levels based on their most recent readings. In the high-CVR group, women had similar CVR levels to men, but higher systolic blood pressure and HbA1c level, and a higher proportion of women were treated with antihypertensive and oral antidiabetic medication. There were substantial levels of poor medication adherence, particularly for cholesterol-lowering medication. Women and men were equally likely to adhere to treatment. Those adhering to relevant medications had lower blood pressure, total-to-HDL cholesterol ratio and HbA1c than non-adherers. Conclusions Pacific men were less likely than Pacific women to have their CVR assessed when indicated, more likely once assessed to have high CVR and equally likely to adhere to treatment. Medication adherence was associated with better control of risk factors and should be further promoted in this population.

Continuing analysis of the primary care data used in the above paper revealed inconsistencies in how the source systems recorded cholesterol measurements which had not previously been noticed. This is reflected in the following corrected paragraphs and table.

Physiological measures and gender

Among the 1201 high-CVR patients, 1167 (97%) had at least three SBP and DBP readings in the past five years and 84% had three BP readings within a window of 15 months (i.e. the latest BP measurement was taken no later than 15 months after the first of three more recent BP readings), 1178 (98%) had total-to- HDL cholesterol ratio results and 1057 (88%) had HbA1c results. The majority of the latest measurements were taken within the last 12 months (94% of BP readings, 75% of lipid results and 76% of HbA1c results). Within the high-CVR group, compared with men, women had a significantly higher SBP and higher HbA1c, but lower Total-to-HDL cholesterol ratio; no significant gender difference in the DBP was observed (median SBP: men = 131.3 mmHg, IQR = 16.67, women = 135.0 mmHg, IQR = 19.67, Wilcoxon– Mann–Whitney test Z = 3.7394, P = 0.0002; median HbA1c: men = 50.0mmol/mol, IQR = 18.83, women = 53.0 mmol/mol, IQR = 21.86, Wilcoxon–Mann– Whitney test Z = 3.6385, P = 0.0003; median Total/ HDL ratio: men = 4.20, IQR = 1.60, women = 3.80, IQR=1.50, Wilcoxon–Mann–Whitney testZ=–5.4033, P<0.0001; median DBP: men = 80.0 mmHg, IQR = 12.00, women = 80.0 mmHg, IQR = 13.33,Wilcoxon– Mann–Whitney test Z = –0.8310, P= 0.4060.

Physiological measures and medication adherence

The high-CVR patients who were prescribed antihypertensive, cholesterol-lowering, and/or oral antidiabetic medication in the last two years (irrespective of their adherence status) were found to have a higher SBP (with no significant difference in DBP) and higher HbA1c than those not on treatment, but a lower mean total-to-HDLcholesterol ratio than those not on treatment (median SBP: treated = 133.3 mmHg, IQR = 18.67, not treated = 130.0 mmHg, IQR = 18.17, Wilcoxon–Mann–Whitney test Z = –2.6450, P = 0.0082; median DBP: treated = 80.0 mmHg, IQR = 13.33, not treated = 80.0 mmHg, IQR = 11.33, Wilcoxon–Mann–Whitney test Z = 0.3924, P = 0.6947; median total-to-HDL ratio: treated = 3.90, IQR = 1.50, not treated = 4.40, IQR = 1.70, Wilcoxon– Mann–Whitney test Z = –5.0557, P < 0.0001; median HbA1c: treated = 60.0 mmol/mol, IQR = 21.09, not treated = 44.3 mmol/mol, IQR = 6.56, Wilcoxon– Mann–Whitney test Z = –20.5009, P < 0.0001). Those patients who adhered to medication had better results (lower SBP, DBP, total-to-HDL cholesterol and HbA1c) than non-adherers (see Figures 3–5 and Table 3). This effect was also seen when the data were assessed for each gender separately (although not statistically significant for HbA1c in men, or for SBP or total-to-HDL cholesterol in women).

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