Cardiac medication use in patients with suspected ischaemia without obstructive coronary arteries: sex differences
P M C Mommersteeg1, J Roeters van Lennep2, J Widdershoven3,4
1Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands. P.M.C.Mommersteeg@tilburguniversity.edu.
Insights
In patients with ischaemia without obstructive coronary arteries (INOCA), cardiac medication use showed no sex differences. However, psychological distress was linked to different medication patterns in women versus men.
Area of Science:
- Cardiology
- Psychosomatic Medicine
- Pharmacology
Background:
- Ischaemia without obstructive coronary arteries (INOCA) disproportionately affects women and is linked to psychological distress.
- Treatment aims to alleviate angina and manage cardiovascular risk.
- This study investigates sex-based differences in medication use and distress in INOCA patients.
Purpose of the Study:
- To analyze sex disparities in cardiac and non-cardiac medication use among patients with suspected INOCA.
- To explore medication and sex differences associated with consistent psychological distress in this population.
Main Methods:
- An observational cohort study of 488 patients with suspected INOCA.
- Medication data were coded using the Anatomical Therapeutic Chemical (ATC) system.
- Psychological distress was categorized based on validated questionnaires for depression and anxiety.
Main Results:
- No significant sex differences were found in cardiac medication use.
- Women used anxiolytic benzodiazepines more frequently than men.
- Consistent psychological distress was more common in women and associated with specific medication use (ACE inhibitors/ARBs, diuretics) in women and calcium antagonists/lower adherence in men.
Conclusions:
- Cardiac medication use in INOCA patients does not differ by sex.
- Psychological distress in women may correlate with hypertension and related medication, while in men, it may relate to chest pain and subsequent medication use.
Background:
Ischaemia without obstructive coronary arteries (INOCA) is more prevalent in women and associated with psychological distress. Pharmacological treatment goals are angina relief and cardiovascular risk management. The present study aims to examine sex differences in cardiac and non-cardiac medication use, as well as medication and sex differences related to consistent psychological distress in patients with suspected INOCA.
Design:
A TweeSteden mild stenosis observational cohort study in patients with suspected INOCA as detected by ischaemic reason for referral and non-obstructive arteries based on coronary angiography or computed tomography.
Methods:
Medication documented in the hospital records of 488 patients (53% women) was coded as angina relief medication, blood-pressure-lowering medication, antithrombotics, statins, and non-cardiac medication, using the Anatomical Therapeutic Chemical code. Depressive symptoms and anxiety were recoded as 'consistent distress' (above the cut-off score for depression and anxiety on validated questionnaires), 'inconsistent distress' (above the cut-off for depression or anxiety) or 'no distress' (below the cut-off).
Results:
No sex differences were observed in cardiac medication use. Women used anxiolytic benzodiazepines more often (12% vs 4%, p = 0.002) compared to men. Consistent distress was more prevalent in women (22% vs 15%, p = 0.004) and was related to the use of more angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and diuretics in women and to calcium antagonist use as well as lower adherence levels in men. Women who reported chest pain more often received angina relief medication and blood-pressure-lowering medication than men.
Conclusion:
No sex differences were observed in cardiac medication use in patients with suspected INOCA. Psychological distress may reflect hypertension and subsequent medication use in women, and experiencing chest pain and subsequent medication use in men.
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