Analysis of the relationship between sex and prescriptions for guideline-recommended therapy in peripheral arterial disease, in relation to 1-year all-cause mortality: a primary care cohort study

Abstract

ObjectivesTo explore population patterns of sex-based incidence and prevalence of peripheral arterial disease (PAD), guideline-directed best medical therapy prescriptions and its relationship with all-cause mortality at 1 year.DesignA retrospective cohort study.SettingAnonymised electronic primary care from 787 practices in the UK, or approximately 6.2% of the UK population.ParticipantsAll registered patients over 40 with a documented diagnosis of peripheral arterial disease.Outcome measurePopulation incidence and prevalence of PAD by sex. Patterns of guideline-directed therapy, and correlation with all-cause mortality at 1 year (defined as death due to any outcome) in patients with and without an existing diagnosis of cardiovascular disease. Covariates included Charlson comorbidity, sex, age, body mass index, Townsend score of deprivation, smoking status, diabetes, hypertension, statin and antiplatelet prescription.ResultsSequential cross-sectional studies from 2010 to 2017 found annual PAD prevalence (12.7–14.3 vs 25.6 per 1000 in men) and incidence were lower in women (11.6–12.4 vs 22.7–26.8 per 10 000 person years in men). Cox proportional hazards models created for PAD patients with and without cardiovascular disease over one full year analysed 25 121 men and 13 480 women, finding that following adjustment for age, women were still less likely to be on a statin (OR 0.69; 95% CI 0.66 to 0.72; p<0.001) or antiplatelet (OR: 0.87; 95% CI 0.83 to 0.90; p<0.001). Once fully adjusted for guideline recommended medical therapy, all-cause mortality was similar between women and men (adjusted HR (aHR) 0.95, 95% CI 0.87 to 1.03, p=0.198 for all patients, aHR 1.01, 95% CI 0.88 to 1.16, p=0.860 for those with cardiovascular disease).ConclusionsWomen with a new diagnosis of PAD were not prescribed guideline-directed therapy at the same rate as men. However once adjusted for factors including age, all-cause mortality in men and women was similar.

Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score matching study

“…There were no substantial differences in the strength of association between coronary artery disease, ischemic stroke/TIA, or all-cause death risk factors and sex in elderly patients. Our results are similar to the historical reports [ 37 , 38 ].…”

Trimethoprim-sulfamethoxazole prophylaxis during treatment of granulomatosis with polyangiitis with rituximab in the United States of America: a retrospective cohort study

“…However, we did not see a difference in the use of atovaquone or dapsone (which might indicate a known TMP-SMX allergy) according to sex. While our results should be interpreted with caution, especially as we lacked granular data to determine whether the omission of TMP-SMX prophylaxis was clinically justified, prior studies have observed sex disparities in the use of preventative treatments in other conditions such as diabetes [ 39 ] and peripheral artery disease [ 40 ]. The relationship between biological sex (and gender, which we were unable to evaluate) and AAV treatment and prophylaxis choices will require further study.…”