Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome

Abstract

Aims We sought to investigate if sex disparity exists for secondary prevention pharmacotherapy following acute coronary syndrome (ACS) and impact on long-term clinical outcomes. Methods and results We analysed data on medical management 30-day post-percutaneous coronary intervention (PCI) for ACS in 20 976 patients within the multicentre Melbourne Interventional Group registry (2005–2017). Optimal medical therapy (OMT) was defined as five guideline-recommended medications, near-optimal medical therapy (NMT) as four medications, sub-optimal medical therapy (SMT) as ≤3 medications. Overall, 65% of patients received OMT, 27% NMT and 8% SMT. Mean age was 64 ± 12 years; 24% (4931) were female. Women were older (68 ± 12 vs. 62 ± 12 years) and had more comorbidities. Women were less likely to receive OMT (61% vs. 66%) and more likely to receive SMT (10% vs. 8%) compared to men, P < 0.001. On long-term follow-up (median 5 years, interquartile range 2–8 years), women had higher unadjusted mortality (20% vs. 13%, P < 0.001). However, after adjusting for medical therapy and baseline risk, women had lower long-term mortality [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.79–0.98; P = 0.02]. NMT (HR 1.17, 95% CI 1.05–1.31; P = 0.004) and SMT (HR 1.79, 95% CI 1.55–2.07; P < 0.001) were found to be independent predictors of long-term mortality. Conclusion Women are less likely to be prescribed optimal secondary prevention medications following PCI for ACS. Lower adjusted long-term mortality amongst women suggests that as well as baseline differences between gender, optimization of secondary prevention medical therapy amongst women can lead to improved outcomes. This highlights the need to focus on minimizing the gap in secondary prevention pharmacotherapy between sexes following ACS.

Gender Differences in Patients With Stable Chest Pain

“…On the contrary, some studies report less aggressive pharmacological therapy and lower use of revascularization in women. 30,31 Moreover, studies suggest that women with suspected CAD are less likely to be referred for diagnostic procedures than men. 4,32 However, in our study, there was an equal representation of men and women who visited the fast-track outpatient clinic and were referred for CCTA.…”

Cardiovascular disease in women: Do we need new diagnostic and therapeutic strategies?

“…On the other hand, there is a need for dose adjustment of antithrombotic medication based on weight or renal function in females to reduce the incidence of bleeding events [44]. In terms of secondary prevention, women are less likely to receive statins, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers at the time of discharge [45].…”

Gender Differences in All-Cause Mortality after Acute Myocardial Infarction: Evidence for a Gender–Age Interaction

“…Women present with AMI at a later age, with greater cardiovascular risk burdens, and with less opportunity to receive guideline-recommended therapies. However, data are conflicting regarding whether mortality remains higher in women after adjusting for differences in age and other prognostic factors [3,4]. Differences in the age distribution of study samples might explain the inconsistency in results across studies.…”