Disease risk factors in MESA Table 1—Cardiovascular disease risk factors and aspirin use for participants with diabetes, 2000 –2002 Sex Women Men Race/ethnicity and sex subgroups n 448 478 LDL cholesterol (mg/dl) SBP (mmHg) Diastolic blood pressure (mmHg) Pulse pressure (mmHg) A1C (%) Aspirin (%) 112.6 109.6 2.31 2.14 133.3 131.1 1.37 1.26 68.6 75.2 0.64* 0.58 64.7 55.9 1.06* 0.97 7.38 7.44 0.12 0.11 97 (23)* 155 (33) NHW 176 110.5 3.13 129.9 91.83 69.9 0.85 60.0 1.42 7.18 0.16 64 (38) Women 72 110.3 4.49 127.9 2.67 65.9 1.24 62.0 2.06 7.28 0.23 20 (29) Men 104 110.3 3.92 130.8 2.27 73.6 1.05 57.1 1.75 7.14 0.19 44 (44) African American 356 112.2 2.51 135.6 1.49†† 74.7 0.69††† 60.9 1.16 7.65 0.13†† 96 (28)† Women 184 116.3 3.18 136.8 1.89‡‡ 72.1 0.88 64.7 1.46 7.56 1.16 42 (24) Men 172 108.2 3.18 134.4 1.89 77.2 0.87 57.2 1.46 7.75 0.16 54 (32) Hispanic 285 114.1 2.96 135.0 1.75† 70.9 0.81 64.1 1.36† 7.55 0.15 56 (20)††† Women 140 113.7 3.67 136.8 2.18‡‡ 67.0 1.01 69.8 1.69‡‡ 7.46 0.18 22 (16)‡ Men 145 114.5 3.59 133.0 2.12 74.7 0.99 58.4 1.64 7.69 0.18 34 (24) Chinese 109 107.6 4.07 128.4 2.41 72.3 1.12 56.1 1.87 7.24 0.21 36 (34) Women 52 108.9 5.49 130.9 3.24 68.9 1.50 61.9 92.50 7.54 0.29 13 (26) Men 57 106.3 5.06 125.8 2.99 75.6 1.39 50.2 2.31 7.04 0.25 23 (41) Data are means SE or n (%). A1C was from exam 2. Comparisons were adjusted as follows: women vs. men adjusted for age, site, race/ethnicity, income, education level, and health insurance (government-sponsored vs. private vs. no insurance). African American vs. NHW adjusted for the same variables without race/ethnicity and including sex, similarly for Hispanic vs. NHW and Chinese vs. NHW. African American women vs. NHW women adjusted for same variables without sex and race/ethnicity, similarly for Hispanic women vs. NHW women and Chinese women vs. NHW women. *P 0.0001 for comparisons of women vs. men. †P 0.05, ††P 0.01, †††P 0.0001 for comparisons of African American, Hispanic, and Chinese vs. NHW. ‡P 0.05, ‡‡P 0.01 for comparisons of African American, Hispanic, and Chinese women vs. NHW women. (Table 1). African American and Hispanic women had signiﬁcantly higher mean SBP values than NHW women. A signiﬁ- cantly lower percentage of women were taking aspirin (Table 1). Hispanic women reported taking less aspirin than NHW women. A lower percentage of women achieved LDL cholesterol 130 mg/dl (69.4 vs. 77.1%, P 0.01) and SBP 130 mmHg (42.2 vs. 57.8%, P 0.002) compared with men. Women were 9% less likely to achieve LDL cho- lesterol 130 mg/dl than men (adjusted PR 0.91 [0.85– 0.98]) and 9% less likely to achieve SBP 130 mmHg (adjusted PR 0.91 [0.83– 0.99]). African Ameri- can and Hispanic women were 31% (ad- justed PR 0.69 [0.51– 0.91]) and 30% (adjusted PR 0.70 [0.52– 0.95]) less likely, respectively, to achieve blood pressure 130/80 mmHg compared with NHW women. Longitudinal data Of 926 subjects with diabetes at exam 1, 802 completed exam 2, 751 exam 3, and 719 exam 4. At exam 4, LDL cho- lesterol (96.4 vs. 94.6 mg/dl, P 0.54) and SBP (130.3 vs. 127.6 mmHg, P 0.11) did not differ between women and men. At exam 4, there was no dif- ference in the percentage of women 1468 achieving LDL cholesterol 130 mg/dl (adjusted PR 0.97 [0.91–1.04]) or SBP 130 mmHg (adjusted PR 0.95 [0.88 –1.02]) compared with men. African American women were 33% less l i k e l y t o a c h i e v e b l o o d p r e s s u r e 130/80 mmHg (adjusted PR 0.67 [0.49 – 0.91]) compared with NHW women. Although women reported higher antihypertensive and lipid- lowering medication use compared with men at exam 1, there was no dif- ference at exam 4 in antihypertensive (80 vs. 75%, P 0.20) or lipid- lowering medication (51 vs. 49%, P 0.70) use. Aspirin use increased for both sexes from 2000 to 2007; however, women remained less likely to report aspirin use at exam 4 compared with men (44 vs. 57%, P 0.05). Aspirin use remained lower for African American and Hispanic women compared with NHW women (51 and 39% vs. 58%, respectively). CONCLUSIONS — A m o n g M E S A participants with diabetes, at the baseline exam, a lower proportion of women achieved consensus treatment targets for SBP and LDL cholesterol, after adjust- ment for covariates. These differences were observed despite a greater reported use of blood pressure and lipid-lowering medications among women. African American and Hispanic women had lower proportions achieving consensus treat- ment goals for blood pressure and less re- ported use of aspirin compared with NHW women. The sex difference in LDL cholesterol and SBP control diminished over time. Our ﬁndings are consistent with pre- vious reports showing sex and racial/ ethnic differences in cardiovascular risk factor control among individuals with di- abetes (2,12,13,15). Inconsistent ﬁndings have been reported regarding sex and ra- cial/ethnic differences in use of medica- tions for management of cardiovascular factors (3,4,8). There are several potential mechanisms for the sex and racial/ethnic differences we observed. Regression adjustment for socio- economic status variables eliminated the signiﬁcant sex difference in mean SBP. So- cioeconomic variables may correlate with access to high-quality medical care and with personal behaviors that inﬂuence risk factor levels, including medication adherence, diet, and exercise. Our ﬁnd- ings may also indicate a disparity in med- ication titration by physicians. There are several limitations to our study. Information on medication use was self-reported and patient adherence was DIABETES CARE, VOLUME 32, NUMBER 8, AUGUST 2009