E p i d e m i o l o g y / H e a l t h S e r v i c e s R e s e a r c h B R I E F R E P O R T Sex and Racial/Ethnic Differences in Cardiovascular Disease Risk Factor Treatment and Control Among Individuals With Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA) GINGER J. WINSTON, MD1 R. GRAHAM BARR, MD, DRPH1,2 OLVEEN CARRASQUILLO, MD, MPH1 ALAIN G. BERTONI, MD, MPH3 STEVEN SHEA, MD, MS1,2 OBJECTIVE — To examine sex and racial/ethnic differences in cardiovascular risk factor treatment and control among individuals with diabetes in the Multi-Ethnic Study of Atheroscle- rosis (MESA). RESEARCH DESIGN AND METHODS — This study was an observational study ex- amining mean levels of cardiovascular risk factors and proportion of subjects achieving treat- ment goals. RESULTS — The sample included 926 individuals with diabetes. Compared with men, women were 9% less likely to achieve LDL cholesterol 130 mg/dl (adjusted prevalence ratio 0.91 [0.83– 0.99]) and systolic blood pressure (SBP) 130 mmHg (adjusted prevalence ratio 0.91 [0.85– 0.98]). These differences diminished over time. A lower percentage of women used aspirin (23 vs. 33%; P 0.001). African American and Hispanic women had higher mean levels of SBP and lower prevalence of aspirin use than non-Hispanic white women. CONCLUSIONS — Women with diabetes had unfavorable cardiovascular risk factor pro- ﬁles compared with men. African American and Hispanic women had less favorable proﬁles than non-Hispanic white women. P suggest that sex and racial/ethnic opulation-based health survey data disparities are present in diabetes process of care measures and cardiovas- cular risk factor control (1–9). Available data also indicate that sex-speciﬁc race/ ethnicity differences are present in cardio- vascular risk factor control, but these data are limited to Medicare and Veterans’ Hospital patient populations (5,10 –13). We therefore performed analyses of par- ticipants with diabetes in the Multi- Ethnic Study of Atherosclerosis (MESA) Diabetes Care 32:1467–1469, 2009 to examine sex and sex-speciﬁc racial/ ethnic differences in cardiovascular risk factor treatment and control. RESEARCH DESIGN AND METHODS — MESA is a multicenter cohort study of 6,814 men and women age 45– 84 years with no clinical evidence of cardiovascular disease at time of enroll- ment (14). Four MESA exam periods oc- curred between 2000 and 2007. The study was approved by the Institutional Review Board at all participating institu- ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● From the 1Division of General Medicine, Department of Medicine, Columbia University College of Physi- cians and Surgeons, New York, New York; the 2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and the 3Division of Public Health Sciences and Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Corresponding author: Steven Shea, ss35@columbia.edu. Received 10 February 2009 and accepted 22 April 2009. Published ahead of print at http://care.diabetesjournals.org on 12 May 2009. DOI: 10.2337/dc09-0260. © 2009 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for proﬁt, and the work is not altered. See http://creativecommons. org/licenses/by-nc-nd/3.0/ for details. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. DIABETES CARE, VOLUME 32, NUMBER 8, AUGUST 2009 tions, and all MESA participants provided informed consent. Criteria for recruit- ment, data collection methods, and labo- ratory techniques have been previously described (14). Participants were classi- ﬁed as having diabetes if at exam 1 they had a fasting plasma glucose 126 mg/dl, used oral hypoglycemic agents and/or in- sulin, or reported a physician diagnosis of diabetes. Statistical analysis Multivariate models were used to calcu- late predicted means for lipid, blood pres- sure, and A1C levels. Prevalence ratios (PRs) were calculated for percentages of participants achieving cardiovascular risk factor goals using binomial regression, with adjustment for age, MESA site, so- cioeconomic status variables, and either sex or race/ethnicity. Potential effects of selective attrition on longitudinal results were examined using t tests to determine if participants lost to follow-up had higher mean cardiovascular risk factor levels compared with those retained in the study. Analyses were performed using SAS version 9.1. RESULTS — Of 926 MESA partici- pants with diabetes at exam 1 (2000 – 2002), 48% were women. Four racial/ ethnic groups were represented (19% non-Hispanic white [NHW], 38% African American, 31% Hispanic, and 12% Chi- nese). Compared with men, women were more likely to report gross family income $20,000 (42 vs. 26%) and less than high school education (33 vs. 27%). Cross-sectional data At exam 1, after adjustment for age, MESA site, and race/ethnicity, systolic blood pressure (SBP) was 3.5 mmHg higher among women than men (133.7 vs. 130.2 mmHg, P 0.01). LDL cholesterol and A1C did not differ by sex. After additional adjustment for socioeconomic status, there was no sex difference in mean SBP 1467