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Analyzing Sex Differences in Intensity of Cardiovascular Disease Prevention Medications in Patients With Abdominal
Jing Yi Kwan1, Steve Hm Tang2, Henry Davies1
1The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; The Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK.
Insights
Cardiovascular risk prevention in abdominal aortic aneurysm (AAA) patients needs improvement. Women with AAA are less likely to receive lipid-lowering therapy and achieve cholesterol targets, indicating a need for sex-specific care strategies.
Area of Science:
- Vascular Surgery
- Cardiology
- Public Health
Background:
- Patients with abdominal aortic aneurysm (AAA) face high cardiovascular event risk, comparable to those with prior major cardiac events.
- European Society for Vascular Society guidelines recommend antiplatelet and lipid-lowering therapy (LLT) for all AAA patients.
- This study assesses antithrombotic therapy, LLT prevalence, intensity, and lipid monitoring in an AAA surveillance cohort, examining sex-based disparities.
Purpose of the Study:
- To evaluate the prevalence and intensity of antithrombotic and lipid-lowering therapies in an abdominal aortic aneurysm (AAA) surveillance cohort.
- To investigate lipid profile monitoring and achievement of lipid targets within this cohort.
- To identify and analyze any sex-based differences in therapeutic management and outcomes.
Main Methods:
- Retrospective, single-center, cross-sectional study of 614 patients in an AAA surveillance program (2018-2020).
- Utilized electronic health records linked with primary care data for demographics, comorbidities, and medication/laboratory results.
- Employed analysis of covariance to adjust for confounding comorbidities.
Main Results:
- 21% of patients were not on antithrombotic therapy, and 20% were not on LLT, indicating suboptimal care.
- 47% received low/moderate intensity statin therapy, suggesting potential for improved lipid management.
- Female sex was linked to lower LLT prescription rates (P=0.008) and less LDL-C monitoring and target achievement (P=0.040).
Conclusions:
- Significant opportunities exist to enhance cardiovascular risk prevention for both male and female AAA patients.
- Sex disparities are evident in LLT prescription, lipid monitoring, and achieving LDL-C targets, with women experiencing lower rates.
- Addressing these sex-based differences is crucial for optimizing care in AAA patient populations.
Background:
Patients with abdominal aortic aneurysm (AAA) are at a significant risk of cardiovascular events, similar to that of patients who have already experienced a major cardiac event. The European Society for Vascular Society AAA guidelines suggest that antiplatelet therapy and lipid-lowering therapy (LLT) should be considered in all patients with AAA. This study explores the overall prevalence and intensity of antithrombotic therapy and LLT, and lipid profile monitoring in a single center AAA surveillance cohort alongside any sex differences.
Methods:
This was a retrospective, single center, cross-sectional study of 614 patients enrolled in the AAA surveillance program of a tertiary vascular surgery unit. All patients undergoing at least 1 surveillance scan from January 1, 2018, to December 31, 2020, were assessed. Electronic hospital records linked to real-time primary care records were interrogated for data on demographics, comorbidities, antiplatelet and LLT prescriptions, and serum cholesterol laboratory results. An analysis of covariance test was used to account for the effects of confounding comorbidities.
Results:
Twenty-one percent of patients were not on antithrombotic therapy, and 20% of patients were not on LLT which reflects a group of patients receiving sub-optimal clinical care. In total, 47% of the cohort were on low/moderate intensity statin therapy which reflects a group of patients where care can be improved upon. Female sex was independently associated with a reduced likelihood of being prescribed LLT (P = 0.008, eta squared (ηp2) = 0.012, small effect size) but not antithrombotic therapy (P = 0.202). Fewer women underwent low-density lipoprotein cholesterol (LDL-C) monitoring (mean difference 9%, P = 0.040) and achieved the European Society of Cardiology-European Atherosclerosis Society- LDL-C target of <1.4 mmol/L (mean difference 9%, P = 0.040).
Conclusions:
Overall, there is room for improvement in these aspects of cardiovascular risk prevention for both sexes. Sex differences in the prescription of LLT, the prevalence of lipid profile monitoring, and likelihood of achieving LDL-C targets exist among patients with AAA, with a lower prevalence in women.
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