Cardiovascular risk and disease management in diabetes: differences between women and men

Diabetes is one of the most common chronic diseases worldwide. Individuals with diabetes are at increased risk of developing a wide variety of complications, including cardiovascular diseases (CVD). CVD consist of a group of disorders affecting blood vessels and the heart, including heart attacks and strokes. Diabetes is a stronger risk factor for the development of CVD in women than men. The mechanisms underpinning this sex difference are uncertain, and there is need for a better understanding of this sex difference. Potential mechanisms may include differences in biology and disparities in the provision and uptake of healthcare. The overarching objective of this thesis was to provide further insight in the mechanisms underpinning the observed sex differential in the association between diabetes and CVD risk, mainly those related to the provision and uptake of healthcare. The results of this thesis demonstrate that, among the Dutch population with diabetes, sex differences in risk factor assessment, treatment and risk factor control are small, except for levels of body mass index, which are considerably higher in women with diabetes compared to their male counterparts. No consistent pattern of sex differences in the assessment of cardiovascular risk factors and diabetes-related screening activities was found, suggesting that disparities in the provision and uptake of healthcare do not account for the higher relative risk of CVD, conferred by diabetes, in women compared with men.