Sex Differences in Medication Adherence and Medication-Associated Mortality After Coronary Artery Bypass Grafting
Jouko Nurkkala1,2, Aleksi Winstén3, Jenni Toivonen1,2
1Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
Insights
Medication adherence after coronary artery bypass grafting (CABG) was similar in men and women. Beta blocker adherence showed a greater mortality benefit in women, suggesting potential sex differences in secondary prevention efficacy.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Women exhibit higher mortality rates post-coronary artery bypass grafting (CABG) compared to men.
- Investigating secondary prevention medication adherence is crucial to understand these sex-based disparities.
Purpose of the Study:
- To determine if medication adherence explains sex differences in mortality after CABG.
- To analyze the association between adherence to statins, beta blockers, and RAAS inhibitors and all-cause mortality in CABG patients.
Main Methods:
- Utilized data from 9,857 CABG participants (18% women) from 1998-2021.
- Assessed medication adherence via nationwide drug purchase registers.
- Employed multivariable-adjusted Cox regression with sex interaction terms.
Main Results:
- Similar post-CABG medication use (statins, RAAS inhibitors, beta blockers) in men and women.
- High adherence maintained over 10 years, with a trend towards greater adherence in women.
- Medication use reduced mortality in both sexes; beta blocker adherence showed a significantly greater benefit in women (p=0.04).
Conclusions:
- No significant sex differences in medication adherence were found over 10 years post-CABG.
- Beta blocker adherence demonstrated a more pronounced mortality reduction in women compared to men.
- Further research into sex-specific efficacy of secondary prevention medications in CABG patients is warranted.
Aims:
Higher mortality rates after coronary artery bypass grafting (CABG) have been reported in women than in men. We examined whether adherence to secondary prevention medications could explain these sex differences.
Methods:
We used data from 9,857 participants (18% women) who underwent CABG between 1998 and 2021. Medication adherence for statins, beta blockers, and renin-angiotensin-aldosterone system (RAAS) inhibitors was assessed using nationwide drug purchase registers. Multivariable-adjusted Cox regression models with a sex interaction term were used to analyze the association between adherence and all-cause mortality.
Results:
Use of statins (90%), RAAS inhibitors (62%), and beta blockers (93%) was similar in men and women immediately after CABG (P≥0.57 for all). After 10 years, adherence remained high for statins (84%), beta blockers (85%), and RAAS inhibitors (66%), with a non-significant trend towards greater adherence in women. Use of medications was associated with lower mortality in men and women, and particularly for statins (HR, 0.49; 95% confidence interval [CI], 0.41-0.59 for women; HR, 0.54; 95% CI, 0.50-0.59 for men; p for interaction 0.08). Beta blocker adherence was associated with a greater mortality benefit in women compared to men (HR, 0.66; 95% CI 0.55-0.78 versus HR, 0.82; 95% CI, 0.75-0.90; p for interaction 0.04).
Conclusions:
No major sex differences in medication adherence were observed during 10 years of follow-up. Use of beta blockers was associated with lower risk of mortality in women compared with men. Future interventional trials should focus on the potential sex differences in efficacy of secondary prevention medication in CABG patients.
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