Coronary disease & ACSCohort study
Prognostic impact of high-intensity lipid-lowering therapy under-prescription after acute myocardial infarction in women
- Registry-based cohort study
- nationwide registries
- propensity-score matched analysis
Authors' 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
Main finding
High-intensity LLT prescribed at discharge · discharge
Adjusted odds ratio
0.78
95% CI 0.71–0.87
P < 0.001
By group
Women
54
%
Men
68%
Women vs 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 | Estimate | P value | |
|---|---|---|---|
| Other recommended treatments at discharge (female sex) — Women vs Men · beta-blockers | adjusted OR 0.98 (95% CI 0.88–1.10) | P = 0.78 | |
| Other recommended treatments at discharge (female sex) — Women vs Men · renin-angiotensin blockers | adjusted OR 0.94 (95% CI 0.85–1.03) | P = 0.18 | |
| Survival and infarct- and stroke-free survival in women, high-intensity LLT at discharge vs none · 5 years — High-intensity LLT vs Men · survival | adjusted HR 0.74 (95% CI 0.64–0.86) | P < 0.001 | |
| Survival and infarct- and stroke-free survival in women, high-intensity LLT at discharge vs none · 5 years — High-intensity LLT vs Men · infarct- and stroke-free survival | adjusted HR 0.81 (95% CI 0.74–0.89) | P < 0.001 | |
| Survival and infarct- and stroke-free survival in women, high-intensity LLT at discharge vs none · 5 years — High-intensity LLT vs Men · propensity 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:10.1093/eurjpc/zwae255
Summarised from the published abstract; every number is checked against it