Risk factors

Sex disparities persist in management of coronary heart disease


Australian women with coronary heart disease (CHD) continue to miss out on cardiovascular risk factor assessments and medications such as antihypertensives and statins compared to their male counterparts, a new study shows.

Analysis of GP records for 130,926 patients with a history of CHD from 2014-2018 has shown that lower proportions of women were assessed for cardiovascular risk factors such as serum lipids (women 70%–76%, men 77%–81%). BMI was not commonly assessed for either women (59%) or men (62%), similarly waist measurement was done for only 23% of women and 25% of men.

Women were significantly less likely than men to be prescribed guideline-recommended antiplatelet agents, ACE inhibitors, beta-blockers and statins. Only about 22% of eligible women and 34% cent of men were prescribed all four recommended medications. And 21% of women and 10% of men with CHD were not prescribed any of these four medications

Paradoxically, despite the differences in CHD management, women were more likely to achieve treatment targets than men: 82% of women and 76% of men achieved four or more targets for  risk factors.

“Our study shows that people with a history of CHD, particularly women and people aged less than 45 years, are less likely to have their condition managed according to current clinical guidelines,” concluded researchers from La Trobe University in Victoria.

Study lead investigator Professor Professor Rachel Huxley, an epidemiologist at La Trobe UniversityMelbourne, said the persisting sex disparities in the management of CHD in primary care reflected misperceptions that women were at lower risk than men.

“There’s a widely-held assumption that CHD only affects older men, but almost half of people who die from the disease are women,” she said.

“We need new ways to address these gaps and the sex inequity.”

The National Heart Foundation’s Director of Prevention, Ms Julie Anne Mitchell, said research consistently highlighted that women were “invisible when it comes to heart disease”.

“Heart health checks, lifestyle changes and appropriate medications are just as important for women as they are for men,” Ms Mitchell said.

“These findings challenge all clinicians to keep this in mind when assessing patients.”

“Australian research highlights that total healthcare spending on women with heart disease is less than half of that spent on men, and this latest research shows yet again why we need to redress the imbalance,” she said.

The findings are published in the journal Heart.

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