SEX DIFFERENCES IN PHARMACOLOGIC OPTIMAL MEDICAL THERAPY FOR ISCHEMIC HEART DISEASE, 2010-2020: AN OBSERVATIONAL
Hassan A Alhassan1, Harnoor Mann2, Leonard Chiu3
1Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Insights
Women with ischemic heart disease (IHD) receive less optimal medical therapy (OMT) than men, with persistent sex disparities in antiplatelet, statin, and RAASi use over a decade. Targeted strategies are needed to improve cardiovascular prevention for women.
Area of Science:
- Cardiovascular Medicine
- Health Disparities
- Preventive Cardiology
Background:
- Guideline-recommended optimal medical therapy (OMT) for ischemic heart disease (IHD) includes antiplatelets, statins, RAASi, and beta-blockers.
- Substantial sex disparities in OMT utilization have been documented.
- The impact of national efforts on mitigating these disparities in contemporary cohorts remains unclear.
Purpose of the Study:
- To evaluate contemporary trends in OMT utilization for secondary prevention of IHD.
- To assess sex-based disparities in OMT use and guideline-recommended combinations.
- To determine if these disparities have changed over the past decade.
Main Methods:
- Analysis of 2011-2020 National Health and Nutrition Examination Survey (NHANES) data.
- Inclusion of adults with self-reported IHD (myocardial infarction or coronary heart disease history).
- Assessment of OMT use (antiplatelets, statins, RAASi, beta-blockers) via self-report and medication verification, stratified by sex.
Main Results:
- Among 1,905 adults, women had lower OMT use: antiplatelets (68.0% vs 77.7%), statins (57.2% vs 73.9%), RAASi (45.6% vs 59.0%), and beta-blockers (51.2% vs 61.1%).
- Women were less likely to use guideline-recommended combinations, including aspirin plus statins (47.4% vs 64.1%) and all four OMT classes (17.5% vs 32.5%).
- Adjusted analyses showed women remained less likely to use antiplatelets, statins, and RAASi, with disparities consistent from 2011-2020.
Conclusions:
- Women with IHD are significantly less likely than men to receive guideline-directed OMT.
- Persistent sex-based disparities in OMT utilization for IHD secondary prevention exist over the past decade.
- Targeted strategies are essential to address and close the sex gap in cardiovascular prevention.
Background:
Despite guideline recommendations for optimal medical therapy (OMT) in the secondary prevention of ischemic heart disease (IHD)-including antiplatelets, statins, renin-angiotensin-aldosterone system inhibitors (RAASi), and β-blockers-substantial sex disparities in OMT utilization persist. The extent to which national efforts have mitigated these disparities in contemporary cohorts remains unclear.
Methods:
We analyzed data from the 2011-2020 National Health and Nutrition Examination Survey (NHANES) cycles, identifying adults with self-reported IHD (defined as a history of myocardial infarction or coronary heart disease). OMT use in the preceding 30 days was assessed based on participant report and verified through medication containers when available. We evaluated trends in individual drug classes and common combinations, stratified by sex.
Results:
Among 1,905 adults (mean age 65.4 years; 40.6% women), women had significantly lower rates of OMT use compared to men, including antiplatelets (68.0% vs 77.7%), statins (57.2% vs 73.9%), RAASi (45.6% vs 59.0%), and β-blockers (51.2% vs 61.1%). Women were also less likely to use guideline-recommended combinations such as aspirin plus statins (47.4% vs 64.1%) and all four OMT classes (17.5% vs 32.5%). After adjustment for sociodemographic and clinical factors, women remained less likely to use antiplatelets (OR 0.71; 95% CI, 0.52-0.94), statins (OR 0.62; 95% CI, 0.40-0.96), and RAASi (OR 0.56; 95% CI, 0.38-0.84), while β-blocker use did not differ significantly. These sex-based disparities were consistent across all survey cycles from 2011 to 2020.
Conclusion:
In this nationally representative study, women with IHD were significantly less likely than men to receive guideline-directed OMT, with persistent disparities over the past decade. These findings underscore the need for targeted strategies to close the sex gap in cardiovascular prevention.
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