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Women less likely to be assessed, receive treatment for CVD than men
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Women were less likely to assessed for CVD risk factors, and younger at-risk women were less likely to be prescribed guideline-recommended medications compared with their male counterparts, according to data from Australia published in Heart.
“Previously, CVD was assumed to be more prevalent in men, and therefore, women tended to be less intensively treated,” Karice K. Hyun, PhD, of The George Institute for Global Health at the University of Sydney, and colleagues wrote. “To close the treatment gap between women and men, the improvement of [CV] health in women has been promoted through health initiatives and research. Yet, in Australia, as in the United States and the [United Kingdom], women have a higher number of [CV] deaths per year than men (23,755 vs. 21,867 deaths in 2012).”
Hyun and colleagues sampled records of routinely attending patients from 60 Australian primary health care services. The researchers determined the rate of CVD risk information being recorded for sufficient guideline-recommended CVD risk and the rate of optimal preventive medication prescriptions.
Overall, only 43.3% of patients were assessed for all necessary CVD risk factors for a risk assessment. Of the 53,085 participants (58% women), women were less likely to have sufficient CVD risk factors measured (adjusted OR = 0.88; 95% CI, 0.81-0.96).
In the CVD and high CVD risk subgroup (n = 13,294; 47% women), women were more likely than men to be prescribed guideline-recommended medications (adjusted OR = 1.12; 95% CI, 1.01-1.23). However, younger women (aged 35 to 54 years) were significantly less likely to be prescribed the medications (OR = 0.63; 95% CI, 0.52-0.77). Women aged at least 65 years in the CVD/high CVD risk subgroup were more likely than men to be prescribed the recommended medications (OR = 1.34; 95% CI, 1.17-1.54).
“Despite guidelines recommending that risk factors should be assessed and managed in both sexes, inequalities remain,” the researchers wrote. “Women are not receiving equitable testing in Australian primary health care and, while women in general received appropriate medication more often than do men, younger women with CVD/high risk of CVD are disadvantaged in terms of receipt of essential treatments to prevent CVD events. System-wide solutions to these inequalities and the increase of the overall rates of assessment and management of CVD are needed.” – by Cassie Homer
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Gina Lundberg, MD, FACC
This article on gender inequalities in CV risk factor assessment and management in primary care is an important article and relevant to women in the United States.
In the study, which was done in Australia, the women were seen by general practice physicians, and most of them were found to have suboptimal identification and treatment of CV risk factors. This was particularly true in the women aged 54 years or younger. However, women older than 65 years were more likely to be prescribed appropriate medications for CV risk reduction. Younger women were less often prescribed BP medications, antiplatelet therapy and statin therapy. Interestingly, younger women were more often given anticoagulants. The paradox is that we have been encouraging physicians to be more aggressive with young women, giving them BP and cholesterol therapy. And we're trying to get more physicians to prescribe anticoagulants to older women with atrial fibrillation. We obviously still have work to do for women at both ends of the age spectrum.
Another recent study (Dean CA, et al. J Womens Health. 2017;doi:10.1089/jwh.2015.5613) showed that in the United States, most women are seen by obstetrics/gynecology physicians for their primary care, particularly during the reproductive years. They also showed suboptimal treatment of CV risk factors. In particular, these physicians were less likely to test cholesterol, record BMI for obesity or educate on smoking cessation.
Women need aggressive CV risk reduction even in the childbearing years. Heart disease deaths in women has been coming down over the last 10 years, but we are not seeing this reduction in the younger women. We need to be more intentional about encouraging healthier lifestyles in our younger women. And when appropriate, we need to start medical therapy.
All the health care providers who care for women need to be implementing current guidelines for BP, cholesterol, prevention of heart disease in women and prevention of stroke in women.
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