Prognostic impact of high-intensity lipid-lowering therapy under-prescription after acute myocardial infarction in women
Main finding · High-intensity LLT prescribed at dischargeResult — go to the resultAdjusted odds ratio 0.78 95% CI 0.71–0.87Authors' conclusion
Women suffer from a bias regarding the prescription of high-intensity LLT after AMI, which did not attenuate between 2005 and 2015, with potential consequences on both survival and risk of cardiovascular events.
Study context
- Population
- Patients admitted for acute myocardial infarction (AMI) ≤ 48 h from onset over 1 month in 2005, 2010 and 2015 (FAST-MI registries), with long-term follow-up28% women
- Participants
- 12,659 patients
- Exposure
- Women vs men; high-intensity lipid-lowering therapy (LLT) vs none in women
- Womenn = 3,547
- Outcome
- High-intensity LLT prescription at discharge (atorvastatin ≥ 40 mg or equivalent, or statin + ezetimibe) and its association with long-term outcomes in women
- Follow-up
- Discharge; 5 years
Methodological detailsnationwide registries, propensity-score matched analysis
- Nationwide registries
- Propensity-score matched analysis
Main finding
High-intensity LLT prescribed at discharge
Adjusted odds ratio
0.78
95% CI 0.71–0.87
P < 0.001
By group
Women
54
%
Men
68%
Womenvs Men
adjusted OR 0.78 (95% CI 0.71–0.87); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Adjusted OR (95% CI) | P value | |
|---|---|---|---|
| Other recommended treatments at discharge (female sex)Womenvs MenBeta-blockers | 0.98 (0.88–1.10) | P = 0.78 | |
| Other recommended treatments at discharge (female sex)Womenvs MenRenin-angiotensin blockers | 0.94 (0.85–1.03) | P = 0.18 | |
| 0.512Adjusted odds ratio (log scale) |
Survival and infarct- and stroke-free survival in women, high-intensity LLT at discharge vs none · 5 years
| Estimate | P value | ||
|---|---|---|---|
| High-intensity LLTSurvival | adjusted HR 0.74 (95% CI 0.64–0.86) | P < 0.001 | |
| High-intensity LLTInfarct- and stroke-free survival | adjusted HR 0.81 (95% CI 0.74–0.89) | P < 0.001 | |
| High-intensity LLTPropensity score-matched analysis, 5-year survival | HR 0.82 (95% CI 0.70–0.98) | P = 0.03 | |
| 0.512Ratio (log scale) |
High-intensity LLT at discharge by year (women vs men)
- 2005: 25 vs. 35%
- P = 0.14
- 2010: 66 vs. 79%
- P < 0.001
- 2015: 67 vs. 79.5%
- P = 0.001
Original publication
Prognostic impact of high-intensity lipid-lowering therapy under-prescription after acute myocardial infarction in women. Eur J Prev Cardiol. Published 5 August 2024. doi:10.
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