Sex Differences in Acute Coronary Syndrome in a Multiethnic Asian
                        Population: Results of the Malaysian National Cardiovascular Disease
                        Database—Acute Coronary Syndrome (NCVD-ACS) Registry

Lu, Hou Tee; Nordin, Rusli Bin; Ahmad, Wan Azman Wan; Lee, Chuey Yan; Zambahari, Robaayah; Ismail, Omar; Liew, Houng Bang; Sim, Kui Hian; Investigators, Ncvd

doi:10.1016/j.gheart.2014.06.001

Cited by 31 publications

(27 citation statements)

References 38 publications

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“…This situation is unavoidable, as the incidence of MI among the Malaysian population is more prevalent in men than in women. 51 , 52 Another plausible explanation of medication nonadherence among men is the apprehension of the medication side effects (erectile dysfunction with β-blockers), 18 as evidenced in rigorous clinical trials. 53 , 54 …”

Section: Discussionmentioning

confidence: 99%

The prevalence of medication nonadherence in post-myocardial infarction survivors and its perceived barriers and psychological correlates: a cross-sectional study in a cardiac health facility in Malaysia

Ganasegeran¹,

Rashid²

2017

PPA

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BackgroundAlthough evidence-based practice has shown the benefits of prescribed cardioprotective drugs in post-myocardial infarction (MI) survivors, adherence rates remain suboptimal. The aim of this study was to determine the prevalence and factors associated with medication nonadherence among post-MI survivors in Malaysia.Materials and methodsThis cross-sectional study was conducted from February to September 2016 among 242 post-MI survivors aged 24–96 years at the cardiology outpatient clinic in a Malaysian cardiac specialist center. The study utilized an interviewer-administered questionnaire that consisted of items adapted and modified from the validated Simplified Medication Adherence Questionnaire, sociodemographics, health factors, perceived barriers, and novel psychological attributes, which employed the modified Confusion, Hubbub, and Order Scale and the Verbal Denial in Myocardial Infarction questionnaire.ResultsThe prevalence of medication nonadherence was 74%. In the multivariable model, denial of illness (AOR 1.2, 95% CI 0.9–1.8; P=0.032), preference to traditional medicine (AOR 8.7, 95% CI 1.1–31.7; P=0.044), lack of information about illness (AOR 3.3, 95% CI 1.1–10.6; P=0.045), fear of side effects (AOR 6.4, 95% CI 2.5–16.6; P<0.001), and complex regimen (AOR 5.2, 95% CI 1.9–14.2; P=0.001) were statistically significant variables associated with medication nonadherence.ConclusionThe relatively higher medication-nonadherence rate in this study was associated with patient-, provider-, and therapy-related factors and the novel psychological attribute denial of illness. Future research should explore these factors using robust methodological techniques to determine temporality among these factors.

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Section: Discussionmentioning

confidence: 99%

The prevalence of medication nonadherence in post-myocardial infarction survivors and its perceived barriers and psychological correlates: a cross-sectional study in a cardiac health facility in Malaysia

Ganasegeran¹,

Rashid²

2017

PPA

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“…Prescribing variations across groups of interest in NSTEMI patients were examined using binary logistic regression adjusting for covariates and presented as odds ratio (OR) and 95% confidence intervals (CI). Covariates chosen were those shown to impact prescribing trend such as age group, gender [19], ethnicity [9], calendar year, geographical regions [22], presence of risk factors and presence of co-morbidities [1, 2]. For geographical region, the Western Peninsular was chosen as the reference as this region has the most tertiary centers for CV referrals in this country [24].…”

Section: Methodsmentioning

confidence: 99%

“…An increase in the prescribing of evidence-based pharmacotherapies has been described for STEMI [18] while less is known on NSTEMI. In acute interventions of AMI, women [19] and elderly patients [20] were less likely to receive optimal management compared to men and younger patients while no significant variations across ethnicities were observed [21]. Regional variations have remained unexplored.…”

Section: Introductionmentioning

confidence: 99%

Trends and variations in the prescribing of secondary preventative cardiovascular therapies for non-ST elevation myocardial infarction (NSTEMI) in Malaysia

Venkatason

Zaharan

Ismail

et al. 2018

Eur J Clin Pharmacol

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PurposeInformation is lacking on prescribing of preventative cardiovascular pharmacotherapies for patients with non-ST elevation myocardial infarction (NSTEMI) in the Asian region. This study examined the prescribing rate of these pharmacotherapies, comparing NSTEMI to STEMI, and variations across demographics and clinical factors within the NSTEMI group in the multi-ethnic Malaysian population.MethodsThis is a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry from year 2006 to 2013 (n = 30,873). On-discharge pharmacotherapies examined were aspirin, ADP-antagonists, statins, ACE-inhibitors, angiotensin-II-receptor blockers, and beta-blockers. Multivariate logistic regression was used to calculate adjusted odds ratio of receiving individual pharmacotherapies according to patients’ characteristics in NSTEMI patients (n = 11,390).ResultsPrescribing rates for cardiovascular pharmacotherapies had significantly increased especially for ADP-antagonists (76%) in NSTEMI patients. More than 85% were prescribed statins and antiplatelets but rates remained significantly lower compared to STEMI. Women and those over 65 years old were less likely to be prescribed these pharmacotherapies compared to men and younger NSTEMI patients. Chinese and Indians were more likely to receive selected pharmacotherapies compared to Malays (main ethnicity). Geographical variations were observed; East Malaysian (Malaysian Borneo) patients were less likely to receive these compared to Western region of Malaysian Peninsular. Underprescribing in patients with risk factors such as diabetes were observed with other co-morbidities influencing prescribing selectively.ConclusionThis study uncovers demographic and clinical variations in cardiovascular pharmacotherapies prescribing for NSTEMI. Concerted efforts by policy makers, specialty societies, and physicians are required focusing on elderly, women, Malays, East Malaysians, and high-risk patients.Electronic supplementary materialThe online version of this article (10.1007/s00228-018-2451-3) contains supplementary material, which is available to authorized users.

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“…Many ACS studies have shown women to be older and with higher incidences of comorbidities at presentation [ 8 ], [ 9 ]. In Asian populations, sex differences in the demographic characteristics, risk factors, treatments, and outcomes of ACS was demonstrated in a study in Malaysia [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Epidemiology and Risk Factors of Acute Coronary Syndrome in Chinese Patients with Type 2 Diabetes: A Long-Term Prospective Cohort Study

et al. 2015

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ObjectiveDiabetic patients with acute coronary syndrome (ACS) are at higher risk of poor outcome than are non-diabetic patients with ACS. Few studies have focused on sex-related ACS incidence, ACS-related mortality or risk factors to affects sex specific ACS in Chinese with Type 2 diabetes mellitus (T2DM). Based on a hospital-based cohort of Chinese patients with T2DM, we aimed to investigate whether there was sex difference in ACS or ACS-related mortality or risk factors of ACS.MethodsTotally 2,135 Hong Kong Chinese with T2DM were recruited during 1994-1996 and followed up until August 2012. We systematically analyzed sex-related ACS incidence and ACS-related mortality and risk factors with χ2-squared test, descriptive statistics and survival analysis.ResultsRegular follow-up was completed in 2,105 subjects (98.6%), with a median period of 14.53 years. The occurrence of ACS was recorded among 414 patients (19.7%) and ACS-related death among 104 patients (4.9%). ACS incidences increased with age in both men and women, and men had a higher prevalence of ACS than women across different age categories and different follow-up periods (log rank χ2=20.32, P<0.001). The transition of ACS incidences from slow to rapid increase were about 5 years earlier in men (at 51-55 years) than in women (55-60 years). Among ACS patients, cumulative ACS-related mortalities was similar between men and women (log rank χ2=0.063, P=0.802). Besides age and albuminuria, different profiles of risk factors accounted for the occurrence of ACS between men and women.ConclusionsOur findings demonstrated sex differences in ACS incidence and risk factors, but not in ACS-related mortality in Chinese patients withT2DM. These findings suggest that screening and prevention campaigns should be optimized for men and women, which may help to identify diabetic patients at higher risk of coronary heart disease.

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Sex Differences in Acute Coronary Syndrome in a Multiethnic Asian Population: Results of the Malaysian National Cardiovascular Disease Database—Acute Coronary Syndrome (NCVD-ACS) Registry

Cited by 31 publications

References 38 publications

The prevalence of medication nonadherence in post-myocardial infarction survivors and its perceived barriers and psychological correlates: a cross-sectional study in a cardiac health facility in Malaysia

The prevalence of medication nonadherence in post-myocardial infarction survivors and its perceived barriers and psychological correlates: a cross-sectional study in a cardiac health facility in Malaysia

Trends and variations in the prescribing of secondary preventative cardiovascular therapies for non-ST elevation myocardial infarction (NSTEMI) in Malaysia

Sex Differences in Epidemiology and Risk Factors of Acute Coronary Syndrome in Chinese Patients with Type 2 Diabetes: A Long-Term Prospective Cohort Study

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