‘Wake-up call’ as study reveals women less likely to be prescribed cholesterol-lowering drugs than men

1st May 2024

Cholesterol-lowering drugs are less frequently prescribed to women compared to men, despite European Society of Cardiology (ESC) guidelines recommending statins for all patients with chronic coronary syndrome, new research has revealed.

Recommendations for target levels of low-density lipoprotein (LDL) cholesterol are the same for women and men, but previous studies have shown that women are less likely to meet these target levels.

This new retrospective observational study, presented at the recent ESC Preventive Cardiology 2024 congress, considered whether women and men actually receive the same treatments, as is outlined in ESC guidelines.

Electronic health records were used to obtain data on cholesterol levels of 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 years in men and 70 years in women.

Information on dispensed medications was obtained from the Swedish National Prescribed Drug Registry and participants were followed up 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. Additionally, 5% of women were treated with statin plus ezetimibe compared with 8% of men.

Dr Nina Johnston, study author and cardiologist at Uppsala University in Sweden, said: ‘Cholesterol-lowering drugs save lives and prevent heart attacks, and should be prescribed to all patients with coronary artery disease. Unfortunately, our study shows that women are missing out on these essential medications.

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

In all age groups, prescription of cholesterol-lowering treatment was found to be highest at diagnosis and declined over the following three years. This decline was steeper in women compared with men.

For example, in patients under 60 years of age, 65% of women and 79% of men were treated with cholesterol-lowering treatment the week after diagnosis, compared with 52% of women and 78% of men three years later. Achievement of LDL cholesterol targets was also lower in women than men.

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.’

The researchers are currently investigating factors which may explain the observed sex differences.

Undertreatment of women with heart disease increases risk of serious preventable outcomes

11th December 2023

Women who are diagnosed with heart issues are consistently undertreated, leading to preventable heart attacks, strokes and death, according to a new study.

Researchers found that although men had a higher chance of developing heart disease over their lifetime, when heart disease was detected in either sex, women were up to 50% less likely to be treated with preventative medicine compared to men.

The study examined the heart health of approximately 24,000 people over a 25-year period to identify patterns in long-term health outcomes and how they differ between the sexes.

The findings are published in the European Journal of Preventive Cardiology and provide evidence of the need for sex-specific cardiovascular prevention strategies.

Cardiovascular disease is one of the leading causes of death and disability in the UK, Europe and worldwide, and accounts for significant healthcare spending.

Understanding how heart disease affects different populations, including different sexes, is essential in tailoring effective preventative care for individual patients.

Using data from The European Prospective Investigation into Cancer (EPIC)-Norfolk study, the researchers analysed a large population cohort over a very long follow-up period of over 25 years.

The EPIC-Norfolk study also records cardiovascular events, including myocardial infarction, stroke, peripheral artery disease, atrial fibrillation, heart failure and valve disease.

The analysis showed that men had a 49% greater risk of developing heart disease than women over their lifetime and a 43% higher risk of dying from a heart condition compared to women.

The age at which heart disease presented itself was found to be lower in men, with males typically presenting with a heart attack in their 50s. For women, cardiovascular disease would most likely present in their 60s in the form of a stroke or atrial fibrillation.

Despite women presenting later than men, the death rate from cardiovascular disease for women rose to the same level as men. Women were found to have diminishing sex advantage in survival once they developed heart disease.

The researchers believe that the rise in the mortality rate in women is explained by the different preventative treatments that men and women receive.

Dr Tiberiu Pana, honorary clinical research fellow at the University of Aberdeen, said: ‘This is the first study to delineate sex differences from the same population, over very long follow-up while controlling for factors such as lifestyle, socioeconomic status and history of cardiovascular disease.

‘Our analysis found that women were 30-50% less likely to be treated with preventative medicine compared to men.’

Dr Pana said the consistent undertreatment of women with heart or circulatory disorders is ‘worrying’.

She added: ‘Our findings highlight how it is important to consider how future prevention campaigns should focus differently on men and women.’

It is also possible that the menopause may influence outcomes for women, with hormonal changes eroding the early advantage that women have.

Dr Pana suggests that targeted preventative measures around the time of menopause in women may help prevent heart disease.

She said: ‘Everyone should consider minimising their risk factors for heart disease as early as possible in life, such as regularly monitoring their blood pressure, keeping a healthy weight and being physically active.

‘However, it is even more important that people be aware of the need to take preventative medicines after suffering a heart or circulatory disorder to minimise their risk of recurrence or death.’

A version of this article was originally published by our sister publication Nursing in Practice.

No increased risk of menstrual changes after Covid vaccination, large study finds

15th May 2023

A study of almost three million women found no evidence of an increased risk of menstrual changes after Covid vaccination.

Researchers suggested there was a weak association between the vaccine and menstrual disturbance or premenstrual bleeding, in a paper published in the BMJ.

The findings do not provide ‘any substantial support’ for a causal association between the Covid vaccination and healthcare contacts related to menstrual or bleeding disorders, the authors said.

Many women self-report changes to their periods after a Covid vaccine – including excessive, frequent, absent or irregular menstruation – and a link between the vaccine and menstrual disturbance has also been discussed on social media, causing global concern.

‘Weak and inconsistent associations’

The researchers in Sweden drew on high-quality health registry data to evaluate the risks of menstrual disturbance and bleeding after the Covid vaccination in 2,946,448 women aged 12-74 from December 2020 to February 2022.

The authors, led by Rickard Ljung, professor at the Swedish Medical Products Agency, said: ‘We observed weak and inconsistent associations between SARS-CoV-2 vaccination and healthcare contacts for postmenopausal bleeding, and even less consistent for menstrual disturbance, and premenstrual bleeding.’

The healthcare contacts in the study included primary care visits, specialist outpatient visits, and days of hospital stay related to menstrual disturbance or bleeding before or after menopause.

Pfizer-BioNTech, Moderna, and Oxford-AstraZeneca vaccines were all assessed along with the dose number, whether that be unvaccinated, first, second, and third dose.

This was measured over a control period of one to seven days, followed by a second time window of eight to 90 days.

More than 88% of women received at least one Covid vaccination and over 64% of vaccinated women received three doses during the study period.

The highest risks for bleeding in post-menopausal women were seen after the third dose in the one-to-seven-day risk window (28%) and in the eight-to-90-day risk window (25%).

Covid causal effect unlikely

The analysis also suggested a 23-33% increased risk of post-menopausal bleeding after eight to 90 days, with Pfizer-BioNTech and Moderna after the third dose, but a less clear association with Oxford-AstraZeneca.

However, the study concluded that after adjusting for socioeconomic factors, previous healthcare use and specific medical conditions, this almost completely removed weak associations, suggesting a casual effect was unlikely.

A version of this story was originally published by our sister publication Pulse.