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

Yulong Gu, Jim Warren, Natalie Walker, John Kennelly

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.