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Sex Differences in Cardiovascular Medication Prescription
Quick Takes
- Women at high risk for CVD are not prescribed medications such as a statin to the same degree as men at high CVD risk.
- Women with a history of CVD are not prescribed evidence-based medications such as aspirin or ACE inhibitors at the same rates as men with CVD.
Study Questions:
Do cardiac medications differ by sex for adults at high risk for or with cardiovascular disease (CVD)?
Methods:
A systematic literature review was conducted in PubMed and Embase to identify observational studies reporting on sex-specific prevalence of aspirin, statins, and antihypertensive medication prescription among primary care patients, published between 2000 and 2019. Studies were included if published in English, were conducted within primary care, included 1,000 or more participants, and reported on CV medications for both males and females, assessed by prescription (as opposed to self-report). The primary outcome was a comparison of prescription between the two sexes.
Results:
From 10,803 studies identified, 900 were reviewed in full text, of which 43 were included in the present analysis. A total of 2,264,600 participants (28% women) with a mean age ranging from 51-76 years were included. Of the 43 studies, 18 reported on aspirin, 30 on statins, 14 on antihypertensive medications, 21 on beta-blockers, 13 on calcium channel blockers, and 14 on diuretics. Eight studies reported on patients at high risk for CVD, 24 on those with established CVD, and 11 reported on both patient groups. The pooled prevalence of CV medication prescription for women was 41% for aspirin, 60% for statins, and 68% for any antihypertensive medications. Corresponding rates for men were 56%, 63%, and 69%, respectively. The pooled women-to-men prevalence ratios were 0.81 (95% confidence interval [CI], 0.72–0.92) for aspirin, 0.90 (95% CI, 0.85–0.95) for statins, and 1.01 (95% CI, 0.95–1.08) for any antihypertensive medications. Women were less likely to be prescribed angiotensin-converting enzyme (ACE) inhibitors (0.85; 95% CI, 0.81–0.89), but more likely with diuretics (1.27; 95% CI, 1.17–1.37). These findings did not differ by study year, mean age, or mean age difference between the sexes.
Conclusions:
The investigators concluded that sex differences in the prescription of CV medication exist among patients at high risk or with established CVD with a lower prevalence of aspirin, statins, and ACE inhibitor prescription in women and a lower prevalence of diuretics prescription in men.
Perspective:
These data support prior studies, which have observed lower rates of CV medications among women compared to men. These findings add perspective, given the use of primary care populations and the participants being at high risk for or with a history of CVD. Last, these results did not change by study year, suggesting a continued gap in the use of evidence-based medications among women who would benefit.
Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Prevention, Nonstatins, Novel Agents, Statins
Keywords: Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Aspirin, Calcium Channel Blockers, Cardiovascular Agents, Diuretics, Drug Prescriptions, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Primary Health Care, Primary Prevention, Sex Characteristics
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