Over the last couple of decades, men with diabetes have cut their rate of death from cardiovascular disease (CVD) by half. But women? Their prognosis is unchanged. And that could be due to gender bias among doctors-and even among the patients themselves.

"This especially high-risk group is not being treated as well as men," says Ioanna Gouni-Berthold, MD, a professor at the University of Cologne in Germany and lead author of a new study that compared 45,000 men and women with and without preexisting CVD. The study team found that both sexes in the group without CVD had similar levels of A1C and blood pressure, but that the women's LDL cholesterol levels were high-above 130 mg/dl-25 percent more often than men. (The recommended LDL level for people with diabetes and without CVD is below 100 mg/dl.)

The picture is even bleaker for women with CVD, who were under worse control than men with CVD in all three measures. These women were 15 percent more likely to have an uncontrolled A1C (over 8 percent), 19 percent more likely to have uncontrolled systolic blood pressure (over 140 mmHg), and 44 percent more likely to have uncontrolled LDL cholesterol levels (over 130 mg/dl) compared to men. (The recommended LDL level for people with diabetes and CVD is below 70 mg/dl.)

Furthermore, Gouni-Berthold and colleagues found that while both sexes got comparable prescriptions for blood pressure and blood glucose medications, women with CVD received LDL-lowering medications, such as statins, significantly less often than men did. "These are the most important drugs," says Gouni-Berthold, for reducing the risk of CVD death.

Could part of the problem be a perception in the medical community that CVD is a man's disease? "Absolutely," says Gouni-Berthold. But there is another possible factor, given that women with CVD are also not doing as well on A1C and blood pressure, despite comparable prescription rates: Perhaps women themselves are part of the problem, underestimating their CVD risk and, as a result, not taking needed medications. "Compliance is directly related to the belief that the medication they are taking would be of benefit," says Gouni-Berthold. But in fact, heart disease is the number one cause of death in women-and diabetes makes one especially vulnerable.

To ensure that your CVD risk factors are being managed well, ask your doctor whether your LDL cholesterol is at the recommended level. "If the doctor says no," suggests Gouni-Berthold, "ask if maybe they should add another medication." And, of course, take it, as well as your other meds.

The study was published online, Mar. 28, 2008, in Diabetes Care.