GENDER DIFFERENCES IN THE ASSESSMENT OF CARDIOVASCULAR RISK, AND CONTROL OF BLOOD PRESSURE AND LDL-CHOLESTEROL: A SUBANALYSIS OF THE SNAPSHOT STUDY IN EUROPE

Objective: This pre-specified subgroup analysis aims to assess differences in cardiovascular (CV) risk, blood pressure (BP) and LDL-C control between genders in hypertensive patients. Design and method: SNAPSHOT is a cross-sectional, epidemiological, multicentre study conducted in 9443 patients with hypertension from six European countries (Bulgaria, Croatia, Georgia, Romania, Serbia, and Spain). Investigators estimated BP and LDL-C control, and CV risk according to their clinical practice. Estimated CV risk categories were compared to the calculated CV risk based on SCORE2&2-OP. Results: 5281 women and 3996 men were analyzed. Women tended to be older than men (66.9±10.0 years vs. 64.3±11.0 years), while men were more likely to be smokers (21.5% vs. 13.9%) and overweight/obese (BMI 29.6±7.3 kg/m2 vs. 29.2±6.5 kg/m2), p<0.001 for all. Two or more risk factors (age>65years, BMI>30 kg/m2, smoking) were reported in 30.4% of women and in 29.3% of men (in addition to the male gender risk factor). Presence of dyslipidemia and type 2 diabetes were higher in men than women (82.7% vs. 81.1%, p<0.05 and 36.4% vs. 30.8%, p<0.001). Mean SBD/DBP were higher in men than women (139.9±17.0/83.3±11.2 mmHg vs. 138.8±17.4/81.5±10.4 mmHg, p<0.001). According to guidelines, BP was controlled in more women than men (26.7% vs. 21.6%, p<0.001). Mean LDL-C was higher in women than men (123.8±45.9 mg/dL vs. 114.3±46.0 mg/dL, p<0.001). According to guidelines, LDL-C was controlled in less women than men (6.0% vs. 9.9%, p<0.001). Estimated CV risk categories, compared to calculated CV risk, were: very high (18.1% women, 30.1% men vs. 84.7%, 88.4%); high (31.3%, 33.8% vs. 13.5%, 11.1%); and low-to-moderate (50.6%, 36.0% vs. 1.8%, 0.5%). Compared to guidelines, CV risk was more frequently underestimated by investigators in women (76.5%) than in men (65.7%), whereas it was accurately categorized less frequently in women (22.1%) than in men (32.7%) (both p<0.001, Figure).Conclusions: This subanalysis showed that investigators underestimated CV risk more often in women than in men. Women had lower LDL-C control, but better BP control compared to men. When developing and implementing interventions to improve BP control in the European population, we believe gender differences must be considered to improve effectiveness.