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Gender Differences in Guideline-Directed Medical Therapy for Cardiovascular Disease Among Young Veterans
Sanket S Dhruva1,2, James Dziura3,4, Harini Bathulapalli3,5
1San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA. sanket.dhruva@ucsf.edu.
Insights
Women Veterans with heart failure (HF) were half as likely to receive guideline-directed medical therapy compared to men. This highlights significant gender disparities in cardiovascular disease (CVD) care for this population.
Area of Science:
- Cardiology
- Health Services Research
- Gender Health
Background:
- Cardiovascular disease (CVD), including coronary artery disease (CAD) and heart failure (HF), poses a growing health challenge for women Veterans.
- Current clinical practice guidelines advocate for pharmacotherapies to mitigate mortality and adverse cardiovascular events.
Purpose of the Study:
- This study aimed to investigate potential gender-based disparities in the utilization of guideline-directed medical therapy (GDMT) among Veterans diagnosed with incident CAD and HF.
- The research specifically examined differences in prescription patterns between male and female Veterans.
Main Methods:
- A retrospective analysis was conducted on a large cohort of Veterans (N=934,504), including 12.2% women, who served in Operations Enduring Freedom, Iraqi Freedom, and New Dawn.
- The study compared the prescription rates of GDMT for CAD (statins, antiplatelet therapy) and HF (beta-blockers, renin-angiotensin-aldosterone system inhibitors) at 30 days, 90 days, and 12 months post-diagnosis.
Main Results:
- Women Veterans were diagnosed with CAD and HF at younger average ages than men.
- Within 12 months of diagnosis, women had 0.85 odds of receiving CAD medication (95% CI, 0.68-1.08) and 0.54 odds of receiving HF medication (95% CI, 0.37-0.79) compared to men.
Conclusions:
- Young women Veterans with heart failure face significantly lower odds of receiving guideline-directed medical therapy within a year of diagnosis.
- These findings underscore the critical need for targeted strategies to address and reduce gender disparities in cardiovascular care for women Veterans, aiming to prevent adverse outcomes.
Background:
There is an increasing burden of cardiovascular disease, including coronary artery disease (CAD) and heart failure (HF), among women Veterans. Clinical practice guidelines recommend multiple pharmacotherapies that can reduce risk of mortality and adverse cardiovascular outcomes.
Objective:
To determine if there are disparities in the use of guideline-directed medical therapy by gender among Veterans with incident CAD and HF.
Design:
Retrospective.
Participants:
Veterans (934,504; 87.8% men and 129,469; 12.2% women) returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn.
Main Measures:
Differences by gender in the prescription of Class 1, Level of Evidence A guideline-directed medical therapy among patients who developed incident CAD and HF at 30 days, 90 days, and 12 months after diagnosis. For CAD, medications included statins and antiplatelet therapy. For HF, medications included beta-blockers and renin-angiotensin-aldosterone system inhibitors.
Key Results:
Overall, women developed CAD and HF at a younger average age than men (mean 45.8 vs. 47.7 years, p<0.001; and 43.7 vs. 45.4 years, p<0.02, respectively). In the 12 months following a diagnosis of incident CAD, the odds of a woman receiving a prescription for at least one CAD drug was 0.85 (95% confidence interval [CI], 0.68-1.08) compared to men. In the 12 months following a diagnosis of incident HF, the odds of a woman receiving at least one HF medication was 0.54 (95% CI, 0.37-0.79) compared to men.
Conclusions:
Despite guideline recommendations, young women Veterans have approximately half the odds of being prescribed guideline-directed medical therapy within 1-year after a diagnosis of HF. These results highlight the need to develop targeted strategies to minimize gender disparities in CVD care to prevent adverse outcomes in this young and growing population.
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