Persisting gender differences and attenuating age differences in cardiovascular drug use for prevention and treatment of coronary heart disease, 1998–2010

Koopman, Corine; Vaartjes, Ilonca; Heintjes, Edith M.; Spiering, Wilko; Dis, Ineke van; Herings, Ron M. C.; Bots, Michiel L.

doi:10.1093/eurheartj/eht368

Cited by 114 publications

(67 citation statements)

References 28 publications

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“…For example, the age, sex, ethnic and racial characteristics of cardiovascular patients have been widely reported in clinical research. 1,37–39 Numerous studies have also demonstrated that married adults have significantly lower rates of CVD and generally live longer with the disease than those who are not married. 40–42 In terms of socioeconomic background, studies have shown that adults with higher levels of socioeconomic status (i.e., more education and income) have lower rates of cardiovascular illness and better health outcomes than adults with lower levels of socioeconomic status.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

Dupre

Nelson

Lynch

et al. 2017

The American Journal of the Medical Sciences

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Background Recent studies have drawn attention to nonclinical factors to better understand disparities in the development, treatment and prognosis of patients with cardiovascular disease. However, there has been limited research describing the nonclinical characteristics of patients hospitalized for cardiovascular care. Methods Data for this study come from 520 patients admitted to the Duke Heart Center from January 1, 2015 through January 10, 2017. Electronic medical records and a standardized survey administered before discharge were used to ascertain detailed information on patients’ demographic (age, sex, race, marital status and living arrangement), socioeconomic (education, employment and health insurance), psychosocial (health literacy, health self-efficacy, social support, stress and depressive symptoms) and behavioral (smoking, drinking and medication adherence) attributes. Results Study participants were of a median age of 65 years, predominantly male (61.4%), non-Hispanic white (67.1%), hospitalized for 5.11 days and comparable to all patients admitted during this period. Results from the survey showed significant heterogeneity among patients in their demographic, socioeconomic and behavioral characteristics. We also found that the patients’ levels of psychosocial risks and resources were significantly associated with many of these nonclinical characteristics. Patients who were older, women, nonwhite and unmarried had generally lower levels of health literacy, self-efficacy and social support, and higher levels of stress and depressive symptoms than their counterparts. Conclusions Patients hospitalized with cardiovascular disease have diverse nonclinical profiles that have important implications for targeting interventions. A better understanding of these characteristics will enhance the personalized delivery of care and improve outcomes in vulnerable patient groups.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

Dupre

Nelson

Lynch

et al. 2017

The American Journal of the Medical Sciences

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“…In a 2012 AHA national survey of American women, younger women were less aware that cardiovascular disease was the leading cause of death in women and were less likely to engage in activities that reduce cardiovascular risk [34]. Koopman et al, showed that women less than 55 years of age were less likely to be prescribed a lipid lowering agent for primary prevention [35]. Hawkins et al demonstrated that the rate of prescriptions for secondary prevention in stable angina was 10% lower in younger women than men [36].…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age

Epps

Holper

Selzer

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background Women <50 years of age with coronary artery disease (CAD) may represent a group at higher risk for recurrent ischemic events following percutaneous coronary intervention (PCI); however, no long-term, multi-center outcomes assessment exists in this population. Methods and Results Using the NHLBI Dynamic Registry we evaluated the association of sex and age on cardiovascular-related outcomes in10,963 patients (3,797 women, 394 <50 years) undergoing PCI and followed for 5 years. Death, myocardial infarction (MI), coronary artery bypass graft surgery (CABG), and repeat PCI were primary outcomes comprising major adverse cardiovascular events (MACE). While procedural success rates were similar by sex, the cumulative rate of MACE at 1 year was higher in young women (27.8 vs. 19.9%, p=0.003) driven largely by higher rates of repeat revascularizations for target vessel or target lesion failure (CABG: 8.9% vs. 3.9%, p<0.001, adjusted hazard ratio [aHR] 2.4, 95% CI 1.5-4.0; PCI: 19.0% vs. 13.0%, p=0.005, aHR 1.6, 95% CI 1.2-2.2). At 5 years, young women remained at higher risk for repeat procedures (CABG: 10.7% vs. 6.8%, p=0.04, aHR 1.71, 95% CI 1.01-2.88; repeat PCI [target vessel]: 19.7% vs. 11.8%, p=0.002, aHR 1.8, 95% CI 1.24-2.82). Compared to older women, younger women remained at increased risk of MACE, while all outcome rates were similar in older women and men. Conclusions Young women, despite having less severe angiographic CAD have an increased risk of target vessel and target lesion failure. The causes of this difference deserve further investigation. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005677.

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“…Information on drug use came from the PHARMO Database Network, linking pharmacy and hospitalization records of over 2.3 million subjects. [22–24] Data on drug use in the community came from the general practitioners (GP) register HNU (Huisartsen Netwerk Utrecht). Data of major cardiovascular risk factors (blood pressure, cholesterol, body mass index (BMI), diabetes, smoking, physical inactivity) came from the Doetinchem/MORGEN (RIVM) cohort for those aged up to 65 years and the LASA (Longitudinal Aging Study Amsterdam) cohort for those aged 65 years and over.…”

Section: Methodsmentioning

confidence: 99%

Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007

et al. 2016

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ObjectiveWe set out to determine what proportion of the mortality decline from 1997 to 2007 in coronary heart disease (CHD) in the Netherlands could be attributed to advances in medical treatment and to improvements in population-wide cardiovascular risk factors.MethodsWe used the IMPACT-SEC model. Nationwide information was obtained on changes between 1997 and 2007 in the use of 42 treatments and in cardiovascular risk factor levels in adults, aged 25 or over. The primary outcome was the number of CHD deaths prevented or postponed.ResultsThe age-standardized CHD mortality fell by 48% from 269 to 141 per 100.000, with remarkably similar relative declines across socioeconomic groups. This resulted in 11,200 fewer CHD deaths in 2007 than expected. The model was able to explain 72% of the mortality decline. Approximately 37% (95% CI: 10%-80%) of the decline was attributable to changes in acute phase and secondary prevention treatments: the largest contributions came from treating patients in the community with heart failure (11%) or chronic angina (9%). Approximately 36% (24%-67%) was attributable to decreases in risk factors: blood pressure (30%), total cholesterol levels (10%), smoking (5%) and physical inactivity (1%). Ten% more deaths could have been prevented if body mass index and diabetes would not have increased. Overall, these findings did not vary across socioeconomic groups, although within socioeconomic groups the contribution of risk factors differed.ConclusionCHD mortality has recently halved in The Netherlands. Equally large contributions have come from the increased use of acute and secondary prevention treatments and from improvements in population risk factors (including primary prevention treatments). Increases in obesity and diabetes represent a major challenge for future prevention policies.

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Persisting gender differences and attenuating age differences in cardiovascular drug use for prevention and treatment of coronary heart disease, 1998–2010

Cited by 114 publications

References 28 publications

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age

Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007

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