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Women less likely than men to achieve CHD targets

Experts call for tailored strategies to reduce large sex differences in risk factor management

Louise Prime

Thursday, 21 September 2017

Risk factor management for the secondary prevention of coronary heart disease (CHD) is generally substantially poorer among women than it is in men, although the size of the disparity varies between different parts of the world, according to research* published today in Heart. The study’s authors and other experts have called for tailored strategies to reduce these large sex differences in risk factor management, and further investigation into the reasons behind the inequalities.

A team of researchers from the Netherlands, Ireland, South Africa, UK and Australia, set up a study to investigate whether or not there are sex differences in risk factor management of patients with established CHD, and to assess demographic variations of any potential sex differences. Using data covering 10,112 patients with CHD (29% of them women) recruited from Europe, Asia, and the Middle East between 2012-2013, they assessed adherence to guideline-recommended treatment and lifestyle targets, which they summarised as a Cardiovascular Health Index Score (CHIS). They then analysed these data with age-adjusted regression models, to estimate odds ratios for women versus men in risk factor management.

They found that women had better-controlled blood pressure than men (odds ratio [OR] 1.31) and were nearly twice as likely as men to be a non-smoker (OR 1.93). However, compared with men, women were significantly less likely to achieve targets for total cholesterol (OR 0.50), low-density lipoprotein cholesterol (OR 0.57), and glucose (OR 0.78), or to be physically active (OR 0.74) or non-obese (OR 0.82). Overall, women were less likely than men to achieve all treatment targets (OR 0.75) or obtain an adequate CHIS (OR 0.81); but there were no significant sex differences for all lifestyle targets (OR 0.93).

The study authors reported that sex disparities in reaching treatment targets were smaller in Europe than they were in Asia and the Middle East. Also, women in Asia were more likely than men to reach lifestyle targets, with opposing results in Europe and the Middle East.

They suggested that possible explanations for the sex disparity might include that women are more likely than men to be underdiagnosed and less likely to take medication, such as statins; or that women might pay less attention to their CHD risk factor management.

They concluded: “We observed substantial differences between men and women in cardiovascular risk factor management for the secondary prevention of CHD, most often to the detriment of women. Sex disparities in risk factor management differed across regions, suggesting the need for tailored strategies to reduce these inequalities and to improve the uptake of guideline-recommended care for the secondary prevention of CHD in both men and women.”

In their linked editorial,** US researchers welcome this registry’s important contribution to international data on sex difference in ischaemic heart disease (IHD) risk management. But they added: “Knowledge gaps remain, which can be addressed by careful phenotyping of the increasingly available digital medical records and ambulatory monitoring technology, including proteomics, metabolomics and genomics.” They call for further investigation into whether large sex differences in risk factor management (as in the US and Europe) result from lower treatment of women/higher treatment of men; and whether the lower sex differences (seen in Asia and Middle East) are due to lower treatment of both women and men.

* Zhao M, Vaartjes I, Graham I, et al. Sex differences in risk factor management of coronary heart disease across three regions. Heart 2017; 0: 1–8. doi:10.1136/heartjnl-2017-311429

** AlBadri A, Wei J, Mehta PK, et al. Sex differences in coronary heart disease risk factors: rename it ischaemic heart disease! doi 10.1136/heartjnl-2017-311921.

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