Gender Difference in Secondary Prevention of Cardiovascular Disease and Outcomes Following the Survival of Acute Coronary Syndrome

Abstract

Previous studies have shown that women with acute coronary syndrome (ACS) are less likely to receive inhospital care such as revascularisation procedures and secondary prevention medications. Therefore, the aim was to determine if the rate of secondary preventive care and outcomes also differ by sex in patients with ACS at 6 and 12 months after discharge. Methods Of ACS patients recruited from 43 hospitals between 2009 to 2018, 9,283 were discharged alive and followed up at 6 months as part of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE) registry. Multivariable logistic regression models within the framework of generalised estimating equations were used to compare the rate of medication use, smoking, cardiac rehabilitation participation, major adverse cardiovascular event (MACE: myocardial infarction, heart failure or stroke) and all-cause death at 6 and 12 months after discharge between female and male patients. Results Of 9,283 ACS patients, 2,676 (29%) were women. At 6-month post discharge, women were more likely to have comorbidities than men. After adjusting for clinical characteristics, women had lower odds of attending cardiac rehabilitation than men (OR [95% CI]: 0.87 [0.78, 0.98]) and no sex difference in the odds of using 75% of the indicated medications or smoking. Women had higher odds of having a MACE compared to men (1.35 [1.03, 1.77]) but there was no difference for all-cause death between women and men. Moreover, at 12 months after discharge, women were less likely to be on 75% of the indicated medications (0.84 [0.75, 0.95]) but no difference was found in the odds of smoking, MACE and all-cause death.

Differences between men and women in the use of preventive medications following a major cardiovascular event: Australian prospective cohort study

“…Our findings are broadly consistent with previous studies within Australia. Registry data from 43 public hospitals nationwide showed that women hospitalised for ACS are less likely than men to be prescribed recommended medications at discharge, and follow-up self-report data indicated that women were 16% less likely than men to be using at least 75% of the recommended medications (aspirin, other antiplatelet, lipid-lowering medication, beta-blocker and ACE inhibitor/angiotensin II receptor blocker) at 12 months following hospitalisation ( Hyun et al, 2021 ). Results from a representative Australian cross-sectional sample found that more men (50%) than women (34%) with self-reported CVD were using lipid- and blood pressure-lowering medications, with 19% and 23%, respectively, using neither medication ( Banks et al, 2016 ).…”

“…There is evidence that healthcare providers tend to assign women to a lower CVD risk category than men with identical risk factors ( Mosca et al, 2005 , Turnbull et al, 2011 ), even in patients with established CVD ( Turnbull et al, 2011 ). Sex differences in medications prescribed following a CVD event have been shown even when women have more co-morbidities such as hypertension, diabetes, chronic kidney disease and previous cerebrovascular diseases, than men ( Hay et al, 2020 , Hyun et al, 2021 , Khan et al, 2018 ).…”

“…We sought to account for this by requiring at least two dispensings of both medications within 12 months of the index event; sensitivity analyses showed our results were robust to changes in this definition with similar results observed when people with one or more dispensings were considered users. Although we did not include antithrombotic medication usage in our analysis, previous studies show similar sex differences in prescription of antithrombotic medications ( Hyun et al, 2021 , Lee et al, 2019 , Simpson et al, 2005 , Turnbull et al, 2011 ). The data from this study came from the 45 and Up Study which has a response rate of around 18%, comparable to similar international cohort studies.…”

“…Data from Australia show that following a MI or acute coronary syndrome (ACS) event (MI or unstable angina), men are more likely than women to receive ( Hay et al, 2020 , Hyun et al, 2021 , Khan et al, 2018 ) and continue to use ( Hyun et al, 2021 ) recommended preventive medications. Compared with over half (50.3% [95% CI: 39.8–60.8%]) of Australian men, only 34.1% (22.7–45.5%) of Australian women with self-reported broadly defined CVD reported using both blood pressure- and lipid-lowering medications ( Banks et al, 2016 ).…”

“…Similar differences in preventive medication use between men and women with pre-existing CVD have been found within primary care populations ( Driscoll et al, 2011 , Hyun et al, 2017 , Lee et al, 2019 ). Evidence to date has focused on medication use at a single point in time, often prescription at hospital discharge ( Hay et al, 2020 , Khan et al, 2018 , Redfern et al, 2014 ), or relies on self-report data ( Hyun et al, 2021 ). We are lacking large-scale general population data about the longer term use of preventive medications in men and women following a CVD event.…”