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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECardiovascular disease (CVD) is the number one killer of women in westernized countries. Its connection to diabetes, a particularly strong risk factor that disproportionately affects women, has been well established. In a session that was devoted to the implications for CVD prevention and the treatment of women with diabetes. This article discusses differences in current diabetes treatment that are related to gender.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ECardiovascular disease (CVD) is the number one killer of women in westernized countries. Its connection to diabetes, a particularly strong risk factor that disproportionately affects women, has been well established. In a session that was devoted to the implications for CVD prevention and the treatment of women with diabetes, L. Kristin Newby, MD, Duke University Medical Center, Durham, North Carolina, USA, discussed differences in current diabetes treatment that are related to gender.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EMajor randomized controlled trials (RCTs) over the past 1 to 2 decades have changed the practice of CVD prevention in women, with 3 studies having a particular impact on the current guidelines for the prevention of CVD in women. The Women\u0027s Health Initiative (WHI) [Rossouw JE et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2002] and the Heart and Estrogen\/Progestin Replacement Study [Hulley S et al. \u003Cem\u003EJAMA\u003C\/em\u003E 1998] were, in large part, responsible for the recommendation that hormone therapy not be used for the primary or secondary prevention of CVD, as it is not effective and may be harmful [Mosca L et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2007, 2011]. Aspirin is one of the least expensive and most frequently used preventive therapies for cardiovascular events; however, the Women\u0027s Health Study (WHS), which evaluated the use of low-dose aspirin as primary prevention for CVD in women, provided evidence of a sex-based response to aspirin therapy. Among the women in the WHS, aspirin therapy resulted in a significant (p=0.04) overall reduction in stroke (RR, 0.83; 95% CI, 0.69 to 0.99) and a nonsignificant overall 9% reduction in cardiovascular events, a slight increase in the risk of hemorrhagic stroke (RR, 1.24; 95% CI, 0.82 to 1.87; p=NS), and no benefit on myocardial infarction (MI; RR, 1.02; 95% CI, 0.84 to 1.25). To assess for the effect of gender, the authors conducted a gender-specific on aspirin therapy random-effects meta-analysis of data from 6 trials that showed a reduction in risk for MI and no influence on stroke among men but no effect on MI in women and a reduction in the incidence of stroke [Ridker PM et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAspirin resistance is present in up to 40% of patients with diabetes, and the prevalence of resistance increases with decreasing metabolic control [McGuire D. Braunwald\u0027s Heart Disease: A Textbook Of Cardiovascular Medicine 2012. Elsevier]. Large RCTs are currently evaluating if higher doses of aspirin might overcome the effects of resistance, but the 2011 American Heart Association guidelines state that aspirin (75 mg\/day to 325 mg\/day) should be used in women with coronary heart disease unless contraindicated and that this therapy is reasonable in women with diabetes unless contraindicated. Signals of an increased risk of MI among younger women and risks for bleeding led to the recommendation against routine use of aspirin in healthy women aged \u0026lt;65 years to prevent MI [Mosca L et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EFinally, although statin therapy greatly lowers cardiovascular risk, in the WHI study, the incidence of new-onset diabetes mellitus was associated with statin use among postmenopausal women [Culver AL et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2012]. The underpinnings of the recently scrutinized relationship between statin use and new-onset diabetes mellitus are unknown.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAlthough the data generally support similar treatment responses in women and men and although there is no clear evidence that diabetes alters treatment benefit of proven therapies in women, the enrollment of women in RCTs remains low, relative to their overall representation in disease populations (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Melloni C et al. \u003Cem\u003ECirc Cardiovasc Qual Outcomes\u003C\/em\u003E 2010]. To ensure that the evidence that supports treatment is relevant to women, more attention must be focused on increasing recruitment of women into randomized clinical trials.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/30\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Inclusion of Women in RCTs Supporting Women\u0027s Prevention Guidelines.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-158804954\u0022 data-figure-caption=\u0022Inclusion of Women in RCTs Supporting Women\u0027s Prevention Guidelines.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/30\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/30\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/30\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12749\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EInclusion of Women in RCTs Supporting Women\u0027s Prevention Guidelines.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from the American Heart Association. Melloni C et al. Representation of Women in Randomized Clinical Trials of Cardiovascular Disease Prevention. \u003Cem\u003ECirc Cardiovasc Qual Outcomes\u003C\/em\u003E. 2010;3:135\u2013142.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/10\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznffp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznffp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}