Gender differences in evidence-based pharmacological therapy for patients with stable coronary heart disease

Lahoz, Carlos; Mantilla, Teresa; Taboada, Manuel; Soler, Begoña; Tranche, Salvador; López-Rodríguez, Isidro; Monteiro, Beatriz P.; Martín-Jadraque, Raquel; Sánchez-Zamorano, Miguel A.; Mostaza, J.M.

doi:10.1016/j.ijcard.2007.12.115

Cited by 15 publications

(16 citation statements)

References 19 publications

(26 reference statements)

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“…Several studies have indicated less lipid-lowering drug use at older ages and in women [24][25][26]. We also found that the proportion of lipid-lowering drugs was lower in women (19% vs. 71%) prescribed cardiovascular medication and in women (20.2% vs. 68.6%) prescribed concomitant psychotropic medication.…”

Section: Discussionsupporting

confidence: 60%

Concomitant prescription of psychotropic and cardiovascular drugs in elderly patients

Öztürk

Turkyilmaz

2017

Psychiatry and Clinical Psychopharmacology

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Section: Discussionsupporting

confidence: 60%

Concomitant prescription of psychotropic and cardiovascular drugs in elderly patients

Öztürk

Turkyilmaz

2017

Psychiatry and Clinical Psychopharmacology

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“…27 Even though international guidelines do not dictate gender-specific management strategies, women with stable CAD tend to have less access to non-invasive and invasive investigations and receive less intensive medical therapy as well as revascularization. 5–7,9,14,15,28 …”

Section: Discussionmentioning

confidence: 99%

Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry

Steg

Greenlaw

Tardif

et al. 2012

European Heart Journal

463

125

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AimsMen and women differ in terms of presentation and management in coronary artery disease (CAD). Whether these differences translate into different clinical outcomes in stable CAD is unclear. We analysed data from the international prospective CLARIFY registry to compare cardiovascular clinical outcomes in men and women with stable CAD.Methods and resultsWe analysed 1-year outcomes in 30 977 outpatients with stable CAD [23 975 (77.4%) men; 7002 (22.6%) women]. Women were older than men, more likely to have hypertension and diabetes, and less likely to exercise or smoke. They had more frequent angina, but were less likely to have undergone diagnostic non-invasive testing or coronary angiography. Women received less optimized treatment for stable CAD. One-year outcomes were similar for men and women for the composite of cardiovascular death, non-fatal myocardial infarction, or stroke [adjusted rates 1.7 vs. 1.8%, respectively, odds ratio (OR) 0.93, 95% confidence interval (CI) 0.75–1.15]; all-cause death (adjusted 1.5 vs. 1.6%, OR: 0.91, 95% CI: 0.72–1.13); fatal or non-fatal myocardial infarction (adjusted 1.0 vs. 0.9%, OR: 0.81, 95 CI: 0.60–1.08); and cardiovascular death or non-fatal myocardial infarction (adjusted 1.4 vs. 1.4%, OR: 0.89, 95% CI: 0.70–1.12). Fewer women underwent revascularization (2.6 vs. 2.2%, OR: 0.77, 95% CI: 0.64–0.93), although appropriateness was not analysed.ConclusionThe risk profiles of women and men with stable CAD differ substantially. However, 1-year outcomes were similar. Fewer women underwent revascularization. Further research is needed to better understand gender determinants of outcome and devise strategies to minimize bias in the management and treatment of women.

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“…Meanwhile, at 1 year of follow‐up, the combination of antiplatelet and lipid‐lowering therapies was prescribed less for women than for men. Likewise, another study with 8817 patients with previous coronary events showed that women, compared with men, were treated less frequently with beta blockers and statins 8. In contrast, a recent analysis of the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial, in 8966 stable patients with suspected coronary ischemia, showed no sex‐related differences in revascularization rates and prescription of aspirin and statins 18.…”

Section: Discussionmentioning

confidence: 99%

“…Female patients have more complex signs and symptoms of ischemia, and the variation in reproductive hormone levels may play a role in CHD pathophysiology and response to treatment. In both acute and chronic settings, several studies have shown that women, compared with men, are less aggressively treated with evidence‐based therapies and less often undergo invasive procedures 4, 5, 6, 7, 8. However, less is known about the relationship of psychosocial factors, sex, and clinical outcomes among patients with CHD 9, 10, 11, 12, 13.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial

Guimarães

Granger

Stebbins

et al. 2017

JAHA

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BackgroundGreater understanding of differences between men and women with coronary heart disease is needed.Methods and ResultsIn this post hoc analysis of the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial, we described psychosocial factors, treatments, and outcomes of men versus women with stable coronary heart disease and explored the association of sex with psychosocial characteristics and cardiovascular risk. Cox proportional hazards models were used to assess the relationship between sex and outcomes. Interactions among sex, psychosocial factors, and the composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke were tested. Of 15 828 patients, 2967 (19%) were women. Among women, 21.2% felt often or always stressed at home (versus 9.8% of men), and 19.2% felt often or always sad or depressed (versus 10.1% of men; all P<0.0001). The median duration of follow‐up was 3.7 years (25th–75th percentiles: 3.5–3.8 years). Use of evidence‐based medications for coronary heart disease at baseline and 24 months was similar between sexes, as were event rates for all outcomes analyzed. In the multivariable model including psychosocial measures, female sex was associated with lower cardiovascular risk. There was a statistically significant interaction (P=0.03) such that the lower risk in women varied by depressive symptom frequency, whereby women who were more depressed had a risk similar to men.ConclusionsFemale sex was independently associated with better long‐term clinical outcomes, although this was modified by frequency of depressive symptoms. This suggests that emotional state may be an important target for improving outcomes in patients with coronary heart disease, specifically in women.Clinical Trial RegistrationSTABILITY ClinicalTrials.gov number (NCT00799903).

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Gender differences in evidence-based pharmacological therapy for patients with stable coronary heart disease

Cited by 15 publications

References 19 publications

Concomitant prescription of psychotropic and cardiovascular drugs in elderly patients

Concomitant prescription of psychotropic and cardiovascular drugs in elderly patients

Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry

Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial

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