Women with heart disease ‘less likely’ to receive drugs than men

The study authors said their findings, which related to patients with coronary artery disease, should be a “wake-up call” about the undertreatment of women.

“Unfortunately, our study shows that women are missing out on these essential medications”

Nina Johnston

Their findings were presented today at ESC Preventive Cardiology 2024, a conference organised by the European Society of Cardiology (ESC), in Athens.

The researchers noted that patients with coronary artery disease, also called chronic coronary syndrome, required medication to alleviate symptoms and prevent heart attacks and death.

ESC guidelines recommend statins for all patients to lower cholesterol levels in the blood, regardless of whether they are men or women.

If levels are not sufficiently lowered with the maximum tolerated dose of statin, then the guidelines say patients should receive a statin plus another cholesterol-lowering drug called ezetimibe.

Despite having the same recommendations for treatment and targets for low-density lipoprotein (LDL) cholesterol, previous studies have shown women are less likely to meet target levels than men.

This latest retrospective observational study examined whether women and men received the same treatments.

It included 1,037 men and 415 women with a chronic coronary syndrome diagnosed between 2012 and 2020, and who had never had a heart attack. The median age was 68 in men and 70 in women.

Electronic health records were used to obtain data on cholesterol levels. Information on dispensed medications was obtained from the Swedish National Prescribed Drug Registry.

Participants were followed up by the researchers for three years following their diagnosis.

At the end of the third year of follow-up, just 54% of women were treated with cholesterol-lowering drugs compared with 74% of men, according to the study authors.

In addition, they found that 5% of women were treated with a statin plus ezetimibe, compared with 8% of men.

The factors that may explain the observed sex differences are currently under further investigation by the study group.

The researchers also examined treatments and cholesterol levels of women and men diagnosed with a chronic coronary syndrome at different ages – less than 60, 60 to 69.9, 70-79.9, 80 years or older.

In all age groups, prescription of cholesterol-lowering treatment was highest at diagnosis and declined over the following three years, said the study authors.

However, this decline in treatment over time was steeper in women compared with men.

For example, in those under 60, 65% of women and 79% of men received cholesterol-lowering treatment the week after diagnosis, compared with 52% and 78%, respectively, three years later.

Achievement of LDL cholesterol targets was also lower in women than men, according to the study, which was co-funded by pharmaceutical firm Amgen Europe and the Uppsala Region of Sweden.

“Cholesterol-lowering drugs save lives and prevent heart attacks, and should be prescribed to all patients with coronary artery disease,” said study author Dr Nina Johnston of Uppsala University.

“Unfortunately, our study shows that women are missing out on these essential medications,” she said.

Dr Johnston added: “Our findings should be a wake-up call about the undertreatment of women with heart disease.

“Equal prescribing practices are needed so that women receive all recommended therapies and are protected from adverse outcomes.”