Sex Differences in Pharmacologic Optimal Medical Therapy for Ischemic Heart Disease

Despite guideline recommendations for optimal medical therapy (OMT) for ischemic heart disease (IHD), sex disparities in pharmacologic treatment remain poorly characterized in recent years.

The objective of the study was to examine sex differences in the use and trends of guideline-recommended OMT among adults with IHD in the United States from 2011 to 2020.

We performed a serial cross-sectional analysis using nationally representative data from the 2011 to 2020 National Health and Nutrition Examination Survey. Adults aged ≥18 years with self-reported IHD were included. OMT was defined as the use of antiplatelets, statins, β-blockers, and renin-angiotensin-aldosterone system inhibitors (RAASi). We examined differences in medication use by sex and evaluated temporal trends stratified by age (<50 vs ≥ 50 years), adjusting for sociodemographic and clinical factors.

Among 1,905 adults with IHD (40.6% women; mean age 65.4 years), women were significantly less likely than men to receive antiplatelets (68.0% vs 77.7%), statins (57.2% vs 73.9%), RAASi (45.6% vs 59.0%), and OMT combinations including all 4 medications (17.5% vs 32.5%). These differences remained after multivariable adjustment, particularly for statins (adjusted OR: 0.62; 95% CI: 0.40-0.96) and RAASi (adjusted OR: 0.56; 95% CI: 0.38-0.84). Sex disparities were most pronounced among adults under 50 years, with slower increases in OMT uptake over time among women.

From 2011 to 2020, women, particularly younger women, remained less likely than men to receive guideline-directed OMT for self-reported IHD. These findings underscore the need for policy and practice interventions to improve equitable treatment in cardiovascular disease.