Cardiology
that women might be managed conservatively (without AVR intervention) longer and undergo AVR less frequently, despite experiencing more symptoms. These findings are concerning. In conclusion, addressing the gender disparities in cardiac care is not only a matter of healthcare equity but also a crucial step towards saving lives and improving the quality of life for countless women across the UK. By recognising the unique symptoms and diagnostic challenges faced by women with heart disease, implementing proactive screening initiatives, and ensuring timely access to life-saving interventions, we can strive towards a future where every individual receives equitable and effective cardiac care, regardless of gender.
References 1. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J. 2010 Dec;18(12):598-602. doi: 10.1007/s12471-010- 0841-y. PMID: 21301622; PMCID: PMC3018605.
2. Wilkinson C, et al. Sex differences in quality indicator attainment for myocardial infarction: a nationwide cohort study. Heart, 2018;0:1–8. doi:10.1136/heartjnl-2018-313959
3. British Heart Foundation. 23% fewer heart operations and other heart procedures in England than before the pandemic. https://
www.bhf.org.uk/what-we-do/news-from-the- bhf/news-archive/2021/december/fewer- heart-operations-procedures-england-nhs- figures-show
4. Open Heart. ‘Valve for Life’: tackling the deficit in transcatheter treatment of heart valve disease in the UK. Available at: https://
openheart.bmj.com/content/openhrt/8/1/ e001547.full.pdf
CSJ
5. Rice CT, et al. Impact of gender, ethnicity and social deprivation on access to surgical or transcatheter aortic valve replacement in aortic stenosis: a retrospective database study in England. Open Heart. 2023 Sep;10(2):e002373. doi: 10.1136/openhrt-2023-002373. PMID: 37788920; PMCID: PMC10565153.
About the author
Dr. Jonathan Byrne has been a Consultant Cardiologist since 2008. Dr. Byrne completed his undergraduate medical training in Bristol and then continued general professional medical training in the South East of England and London. He was awarded a PhD in the academic department of Cardiology at King’s College Hospital in 2004.
Women less likely to receive life-saving drugs
Women with heart disease are less often treated with cholesterol-lowering drugs than men, according to research presented at ESC Preventive Cardiology 2024, a scientific congress of the European Society of Cardiology (ESC).1 “Cholesterol-lowering drugs save lives and
prevent heart attacks, and should be prescribed to all patients with coronary artery disease,” said study author Dr. Nina Johnston of Uppsala University, Sweden. “Unfortunately, our study shows that women are missing out on these essential medications.” Patients with coronary artery disease, also
called chronic coronary syndrome, require medication to alleviate symptoms and prevent heart attacks and death. ESC guidelines recommend statins for all patients to lower cholesterol levels in the blood.2
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. Electronic health records were used to obtain data on cholesterol levels. Information on dispensed medications was obtained from the Swedish National Prescribed Drug Registry. Participants were followed up for three years
following their diagnosis. The researchers found that 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. Factors which may explain the observed sex differences are under further investigation by the research group. The researchers also examined treatments and
If levels are not
sufficiently lowered with the maximum tolerated dose of statin, then patients should receive a statin plus another cholesterol-lowering drug called ezetimibe.2
The recommendations are the
same for women and men. Despite having the same recommendations
for treatment and for target levels of low-density lipoprotein (LDL; “bad”) cholesterol, previous studies have shown that women are less likely to meet target levels than men.3
This study
examined whether women and men receive the same treatments. This was a retrospective observational study that included 1,037 men and 415 women with a
cholesterol levels of women and men diagnosed with a chronic coronary syndrome at different ages (less than 60, 60 to 69.9, 70-79.9, 80 years or older). In all age groups, prescription of cholesterol- lowering treatment was highest at diagnosis and declined over the following three years. This decline in treatment over time 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 said: “Our findings should be a
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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.” Contrary to common belief, cardiovascular
disease kills more women than men, accounting for 45% of all deaths in women which is more than all cancers combined in the 57 ESC member countries.4
References 1 The abstract ‘Lipid-lowering treatment pattern in chronic coronary syndrome - lower proportion of treatment observed among women during 3 years of follow-up’ will be presented during the session ‘Lipid management in different populations’ which took place on 25 April 2024, at the ESC conference.
2 Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41:407–477.
3 Hambraeus K, Tydén P, Lindahl B. Time trends and gender differences in prevention guideline adherence and outcome after myocardial infarction: Data from the SWEDEHEART registry. Eur J Prev Cardiol. 2016;23:340–348.
4 Timmis A, Vardas P, Townsend N, et al. European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J. 2022;43:716–799.
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