Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

Abstract

Background— The prevalence of the use of secondary prevention cardiovascular medications is lower among women than men, but it is unclear if this is a result of lower treatment initiation among women or lower treatment adherence. We aimed to map the treatment pathway for survivors of acute myocardial infarction (AMI) by sex and age. Methods and Results— This retrospective population-based cohort study used linked administrative data sets in British Columbia (2004–2011), which include health care, prescription drugs, sociodemographic, and mortality information. The study cohort included all individuals admitted to hospital for AMI in 2007–2009 and survived for 1 year after hospital discharge. Patients were evaluated for whether they initiated and then subsequently filled prescriptions angiotensin-converting enzyme inhibitors, β-blockers, and statins. More than two thirds of AMI survivors initiated treatment on all appropriate medications, given their contraindications, within 2 months of discharge. Younger men were significantly more likely than younger women to initiate appropriate treatment (adjusted odds ratio, 1.38; 95% confidence interval, 1.10–1.75). By the end of 1 year after discharge, only one third of all AMI survivors filled all appropriate prescriptions for at least 80% of the year. There was no significant difference in adherence to medication therapy between women and men. Conclusions— The majority of AMI survivors either discontinue treatment or do not refill their prescriptions consistently. Women <55 years are significantly less likely to be on optimal therapy by the end of 1 year after discharge, which is driven by a sex disparity in treatment initiation and not treatment adherence.

Gender differences in risk factors and clinical outcomes in young patients with acute myocardial infarction

“…These observations are important because they suggest that the treatment was not identical for both genders. Recent western studies also support our data that women <55 years are significantly less likely to be on optimal therapy 1 year after discharge, which is driven by a gender disparity in treatment initiation and not treatment adherence; this may not be universal, but rather limited to younger age groups 33. Recently, attention has been directed to preventing and treating CHD among young people; however, this is only just the beginning and major challenges remain, such as dispelling the perception that young women who seem to be healthy are at low risk of adverse outcomes.…”

Sex differences in lipid profiles and treatment utilization among young adults with acute myocardial infarction: Results from the VIRGO study

“…26 A potential reason could be that the baseline LDL-C levels of these young patients were not high enough (median of <110 mg/dL) and physicians may consider low- or moderate-intensity statins sufficient. Consistent with previous studies, 13 we also found a significant proportion of patients discontinued statin treatment by 1 month with no appreciable difference between men and women. It is possible that patients with lower education level, lack of health insurance, or lack of money to pay for medications were more likely to stop treatments, 14, 27 resulting in a decrease in treatment adherence.…”

“…12 Evidence suggests that women are less likely than men to receive guideline-recommended therapies and appear to be less adherent to medications. 13, 14 Compared with men, young women with AMI also tend to exercise less, smoke more, and have higher rates of diabetes and obesity -all factors that are strongly associated with lipid abnormalities after AMI. 1, 15 There has yet to be any explanation as to whether these factors are associated with differences in post-AMI lipid and lipoprotein profiles among young men and women.…”

The effects of catastrophic drug plan deductibles on older women's use of cardiovascular medicines: a retrospective cohort study

“…[22][23][24] Our findings concerning the effects of Fair PharmaCare deductibles on access to cardiovascular treatments are consistent with earlier studies of the drug plan in British Columbia. Those studies found that the implementation of income-based deductibles for older residents' drug coverage reduced the use of statins and β blockers (a hypertension drug class).…”