Sex Differences and Trends in Cardiovascular Risk Management: Insights from a Long-Term Primary Care Study

Sex differences and trends in managing cardiovascular risk factors in primary care: a dynamic cohort study

Literature - Geert Smeets et al - BJGP Open 11 February 2025; BJGPO.2024.0175. DOI: https://doi.org/10.3399/BJGPO.2024.0175

Cardiovascular disease (CVD), including conditions like ischaemic heart disease and stroke, remains a major global health concern, contributing significantly to morbidity and mortality. Modifiable risk factors such as unhealthy diet, physical inactivity, and tobacco use play a crucial role in mitigating CVD risks.

In the Netherlands, primary care, particularly through general practitioners (GPs) and nurse-led programs, plays a pivotal role in managing CVD prevention. Since 2010, integrated cardiovascular risk management (CVRM) programs have been implemented by primary care groups, demonstrating significant engagement with 1.2 million patients.

A recent study in the Eindhoven region explored trends from 2013 to 2019 in achieving target levels for biological (e.g., blood pressure, cholesterol) and lifestyle (e.g., smoking, exercise) risk factors among patients enrolled in CVRM care. The study highlighted gender differences, showing that women with established CVD generally fared worse than men across most risk factors, while women without CVD often performed better in lifestyle factors but worse in biological factors compared to men.

Main results

Key findings include improvements in achieving target levels for LDL cholesterol, blood pressure, and renal function over the study period. However, challenges persist, with suboptimal control rates observed in both sexes by 2019. Notably, the study suggests ongoing disparities in medication prescriptions and lifestyle adjustments between genders, underscoring the need for tailored interventions to bridge these gaps.

Conclusion

This research underscores the importance of sustained efforts in primary care to address gender-specific considerations in CVD management, aiming for more equitable outcomes in biological risk factor control and fostering patient-centered care plans to enhance lifestyle modifications

Editorial comment

Guidelines for cardiovascular risk management (CVRM) do not differentiate between treatment targets for women and men, with the exception of responsible alcohol intake. Between 2013 and 2019, improvements in achieving target levels for seven modifiable risk factors were similar for both women and men who participated in a nurse-led, integrated CVRM program. However, the gender differences observed in 2013 for biological risk factors (systolic blood pressure [SBP], low-density lipoprotein [LDL] cholesterol, estimated glomerular filtration rate [eGFR]) remained unchanged over time. On the other hand, the gap between women and men in achieving targets for lifestyle risk factors (alcohol intake, non-smoking, physical activity, body mass index [BMI]) narrowed, indicating progress in reducing gender disparities in lifestyle-related risk management.