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Sex Differences in Pharmacologic Optimal Medical Therapy for Ischemic Heart Disease
Hassan A Alhassan1, Harnoor Mann2, Leonard Chiu3
1Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Insights
Women with ischemic heart disease (IHD) receive less guideline-recommended optimal medical therapy (OMT) than men, especially younger women. This 10-year study highlights persistent sex disparities in cardiovascular care.
Area of Science:
- Cardiology
- Health Services Research
- Sex Differences in Medicine
Background:
- Guideline-recommended optimal medical therapy (OMT) for ischemic heart disease (IHD) is established.
- However, recent sex disparities in pharmacologic treatment for IHD are not well understood.
Purpose of the Study:
- To investigate sex differences in the utilization and trends of guideline-recommended OMT among US adults with IHD.
- The study period was from 2011 to 2020.
Main Methods:
- A serial cross-sectional analysis of nationally representative National Health and Nutrition Examination Survey data (2011-2020).
- Included adults aged ≥18 years with self-reported IHD.
- OMT defined as use of antiplatelets, statins, beta-blockers, and renin-angiotensin-aldosterone system inhibitors (RAASi); analyses adjusted for covariates and stratified by age.
Main Results:
- Among 1,905 adults with IHD, women (40.6%) were less likely than men to receive antiplatelets, statins, RAASi, and comprehensive OMT.
- These disparities persisted after multivariable adjustment, notably for statins (aOR: 0.62) and RAASi (aOR: 0.56).
- Sex disparities were most significant in adults under 50, with slower OMT uptake increases in women over time.
Conclusions:
- From 2011 to 2020, women, particularly younger women, were less likely to receive guideline-directed OMT for IHD.
- Findings indicate a need for interventions to improve equitable cardiovascular disease treatment.
Background:
Despite guideline recommendations for optimal medical therapy (OMT) for ischemic heart disease (IHD), sex disparities in pharmacologic treatment remain poorly characterized in recent years.
Objectives:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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