RESEARCH Open Access Sex-based disparities in cardioprotective medication use in adults with diabetes Sonia Butalia 1,10* , Adriane M Lewin 2 , Scot H Simpson 3 , Kaberi Dasgupta 4,5,6 , Nadia Khan 7 , Louise Pilote 4,6 , Jeffrey A Johnson 8 , William A Ghali 1,2,9 and Doreen M Rabi 1,2,9 Abstract Objective: The identification of sex-based disparities in the use of effective medications in high-risk populations can lead to interventions to minimize disparities in health outcomes. The objective of this study was to determine sex-specific rates of cardioprotective medication use in a large population-level administrative-health database from a universal-payer environment. Research design and methods: This observational, population-based cohort study used provincial administrative data to compare the utilization of cardioprotective medications between women and men in the first year following a diabetes diagnosis. Competing risks regression was used to calculate crude and adjusted sub-hazard ratios for time-to- first angiotensin-converting-enzyme inhibitor, angiotensin receptor blocker, or statin dispensations. Results: There were 15,120 (45.4%) women and 18,174 (54.6%) men with diabetes in the study cohort. Overall cardioprotective medication use was low for both primary and secondary prevention for both women and men. In the year following a diabetes diagnosis, women were less likely to use a statin relative to men (adjusted sub-hazard ratio [aSHR] 0.90, 95% confidence interval [CI] 0.85 to 0.96), angiotensin-converting-enzyme inhibitors (aSHR 0.90, 95% CI 0.86 to 0.94), or any cardioprotective medication (aSHR 0.93, 95% CI 0.90 to 0.97). Conclusions: Cardioprotective medication use was not optimal in women or men. We also identified a health care gap with cardioprotective medication use being lower in women with diabetes compared to men. Closing this gap has the potential to reduce the impact of cardiovascular disease in women with diabetes. Cardiovascular disease is the leading cause of death in both women and men [1]. It is also the leading cause of morbidity and mortality for those living with diabetes. Compared to non-diabetic individuals, women and men with diabetes are two to four times as likely to develop cardiovascular disease [2]. The past two decades have witnessed the introduction of a number of therapies that are highly effective in the primary and secondary pre- vention of cardiovascular disease. There is robust evi- dence that treatment of hypertension and lipids have cardioprotective benefits independent of their respective blood pressure and lipid-lowering effects [3-7]. There is some suggestion that there is differential uti- lization of preventative (both primary and secondary) ther- apies between women and men with diabetes. Several observational studies have documented that women with diabetes have a higher risk factor burden relative to men, and others have demonstrated that women are less likely to achieve recommended targets for blood pressure, chol- esterol and glucose than men [8-10]. There are small scale observational studies that do provide some evidence that women with diabetes are less likely to be treated with car- dioprotective medications and are less likely to be treated to established therapeutic targets [9,10]. However, it is not known if this finding of under-treatment is true at a popu- lation level which is important given the broader implica- tions of such findings. The objective of the present study was to use a large population-level administrative-health database from a universal-payer environment to compare the use of evidence-based cardioprotective medications among women and men with diabetes. * Correspondence: sbutalia@ucalgary.ca 1 Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada 10 Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada Full list of author information is available at the end of the article METABOLIC SYNDROME DIABETOLOGY & © 2014 Butalia et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Butalia et al. Diabetology & Metabolic Syndrome 2014, 6:117 http://www.dmsjournal.com/content/6/1/117