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Sex disparities evident in medication use for ACS
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ANAHEIM, Calif. — Women with ACS were less likely to take secondary prevention medications and more likely to have a secondary event compared with men, according to data presented at the American Heart Association Scientific Sessions.
Karice K. Hyun, MS, PhD student and statistician in the cardiovascular division of The George Institute for Global Health at the University of Sydney, and colleagues analyzed data from 7,303 patients with ACS (mean age, 67 years; 29% women) from 41 Australian public hospitals from the CONCORDANCE registry.
The first 10 consecutive patients of each month aged 18 years or older who presented with ACS symptoms were included in the analysis. Data collected while the patient was in the hospital included medical history, demographics, morbidity, mortality and in-hospital management.
Patients were followed up for 6 months. Data on medication compliance, vital status and rehospitalization were collected by phone call or mail survey.
Outcomes of interest included major adverse CV events, the use of at least 75% of indicated secondary prevention medications and all-cause death 6 months after discharge.
“Although we could have used a different indicator of adherence such as four or five of the five medications, there will be cases where not all five medications are indicated, where some may have contraindications, etc,” Hyun said.
Women were more likely to have a higher Global Registry of Acute Coronary Events (GRACE) risk score compared with men (109 vs. 104; P < .001), in addition to higher incidence of hypertension (P < .01), diabetes (P < .01), medical history of deep vein thrombosis (P < .01) and medical history of atrial fibrillation (P < .01). There were no differences in in-hospital events such as MI (P = .45), stroke (P = .12), HF (P = .38) and major bleeding (P = .28) between the sexes.
Within 6 months after discharge, women were less likely to take aspirin (76% vs. 82%; P < .001), a second antiplatelet therapy (55% vs. 63%; P < .001), beta-blockers (62% vs. 68%; P < .001) and statins (78% vs. 85%; P < .001) vs. men.
Women were also less likely to take at least 75% of the indicated medications compared with men (74% vs. 80%; P < .001). The difference persisted after adjusting for clinical characteristics (OR = 0.86; 95% CI, 0.76-0.97).
Women had a greater chance of having major adverse CV events after adjusting for clinical characteristics compared with men (OR = 1.35; 95% CI, 1.09-1.67). There was no difference between the two groups for all-cause death (OR = 0.93; 95% CI, 0.71-1.22).
“This calls for awareness programs and campaigns to educate the public regarding the secondary prevention to help close the gap between women and men,” Hyun said. – by Darlene Dobkowski
Reference:
Hyun KK. Gender Disparities and Women’s Cardiovascular Disease. American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, Calif.
Disclosure: Hyun reports no relevant financial disclosures.