ATHENS, Greece — Eyebrow-raising new research out of Sweden finds that women with heart disease receive treatment with cholesterol-lowering drugs less often than men. This is leading the study authors to call for “equal prescribing practices” across both men and women.
“Cholesterol-lowering drugs save lives and prevent heart attacks, and should be prescribed to all patients with coronary artery disease,” says study author Dr. Nina Johnston of Uppsala University in a media release. “Unfortunately, our study shows that women are missing out on these essential medications.”
Patients diagnosed with coronary artery disease usually require medication to both alleviate symptoms and prevent heart attacks and death. Guidelines from the European Society of Cardiology recommend statins for these patients in order to lower cholesterol levels found in the blood. If levels do not sufficiently lower with the maximum tolerated dose of statins, then patients should receive a statin plus another cholesterol-lowering drug called ezetimibe. These recommendations are the exact same for women and men.
Despite men and women sharing the very same recommendations for treatment and target levels of low-density lipoprotein (LDL) cholesterol, previous studies have revealed that women are notably less likely to meet target levels than their male counterparts. This study specifically examined whether women and men receive the same treatments.
This project included 1,037 men and 415 women with coronary artery disease, also known as chronic coronary syndrome, diagnosed between 2012 and 2020. None of the participants had ever suffered a heart attack, and their average ages were 68 for men and 70 for women. Researchers used electronic health records to gather data on their cholesterol levels. Additionally, the team obtained information regarding prescribed medications from the Swedish National Prescribed Drug Registry.
All participants were tracked for up to three years after their initial diagnosis. Study authors uncovered that by the end of the third year of follow-up, just 54 percent of women received cholesterol-lowering drugs — compared to 74 percent of men. Also, five percent of women received statins plus ezetimibe, compared with eight percent of men.
The team is still investigating additional factors that may explain these gender differences when it comes to treatment.
The study authors also examined treatments and cholesterol levels among both men and women diagnosed with chronic coronary syndrome at various different ages (less than 60, 60 to 69.9, 70-79.9, and 80 years or older). Across all age groups, prescription of cholesterol-lowering treatment was highest at diagnosis but declined over the following three years.
This observed drop-off in treatment over time was much steeper for women. For instance, among patients younger than 60, 65 percent of women and 79 percent of men received cholesterol-lowering treatment the week after diagnosis. Meanwhile, 52 percent of women and 78 percent of men received the same treatment three years later. Women were also less likely to reach their goals for LDL cholesterol than men.
“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,” Dr. Johnston concludes.
On a relevant closing note, researchers add that contrary to common belief, cardiovascular disease actually kills more women than men, accounting for 45 percent of all deaths in women. That’s more than all cancers combined across all 57 ESC member countries.
The study was presented at ESC Preventive Cardiology 2024, a scientific congress of the European Society of Cardiology (ESC).
