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Weizman O, Hauguel-Moreau M, Tea V, Albert F, Barragan P, Georges JL, Delarche N, Kerneis M, Bataille V, Drouet E, Puymirat E, Ferrières J, Schiele F, Simon T, Danchin N. Prognostic impact of high-intensity lipid-lowering therapy under-prescription after acute myocardial infarction in women. Eur J Prev Cardiol 2024:zwae255. [PMID: 39192488 DOI: 10.1093/eurjpc/zwae255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/27/2024] [Accepted: 07/16/2024] [Indexed: 08/29/2024]
Abstract
AIMS Women are less likely to receive lipid-lowering therapy (LLT) after acute myocardial infarction (AMI). We analysed whether this under-prescription currently persists and has an impact on long-term outcomes. METHODS AND RESULTS The FAST-MI programme consists of nationwide registries including all patients admitted for AMI ≤ 48 h from onset over a 1 month period in 2005, 2010, and 2015, with long-term follow-up. This analysis focused on high-intensity LLT (atorvastatin ≥ 40 mg or equivalent, or any combination of statin and ezetimibe) in women and men. Women accounted for 28% (N = 3547) of the 12 659 patients. At discharge, high-intensity LLT was significantly less prescribed in women [54 vs. 68% in men, P < 0.001, adjusted odds ratio (OR) 0.78(95% confidence interval (CI) 0.71-0.87)], a trend that did not improve over time: 2005, 25 vs. 35% (P = 0.14); 2010, 66 vs. 79% (P < 0.001); 2015, 67 vs. 79.5% (P = 0.001). In contrast, female sex was not associated with a lack of other recommended treatments at discharge: beta-blockers [adjusted OR 0.98(95% CI 0.88-1.10), P = 0.78], or renin-angiotensin blockers [adjusted OR 0.94(95% CI 0.85-1.03), P = 0.18]. High-intensity LLT at discharge was significantly associated with improved 5 year survival and infarct- and stroke-free survival in women [adjusted hazard ratios (HR) 0.74(95% CI 0.64-0.86), P < 0.001 and adjusted HR: 0.81(95% CI: 0.74-0.89); P < 0.001, respectively]. Similar results were found using a propensity score-matched analysis [HR for 5 year survival in women with high-intensity LLT: 0.82(95% CI 0.70-0.98), P = 0.03]. 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.
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Affiliation(s)
- Orianne Weizman
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), 20 rue Leblanc, 75015 Paris, France
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), CHU Ambroise Paré, 9 avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Marie Hauguel-Moreau
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), CHU Ambroise Paré, 9 avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Victoria Tea
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), 20 rue Leblanc, 75015 Paris, France
| | - Franck Albert
- Department of Cardiology, Centre Hospitalier Louis Pasteur, 4 Allée Claude Bernard, 28630 Le Coudray, France
| | - Paul Barragan
- Department of Cardiology, Polyclinique Les Fleurs, 322 Avenue Frédéric Mistral, 83190 Ollioules, France
| | - Jean-Louis Georges
- Department of Cardiology, Centre Hospitalier de Versailles, Hôpital André Mignot, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Nicolas Delarche
- Department of Cardiology, Centre Hospitalier de Pau, 4 Bd Hauterive, 64000 Pau, France
| | - Mathieu Kerneis
- ACTION Study Group, Department of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Cardiology Institute, Boulevard de l'Hôpital, 75013 Paris, France
| | - Vincent Bataille
- Department of Cardiology B and Epidemiology, Toulouse University Hospital, UMR INSERM 1027, 2 Rue Charles Viguerie, 31300 Toulouse, France
| | - Elodie Drouet
- Department of Clinical Pharmacology, AP-HP, Hôpital Saint Antoine, and Unité de Recherche Clinique (URCEST), 184 Rue du Faubourg Saint Antoine, 75012 Paris, France
- Université Pierre et Marie Curie (UPMC-Paris 06), INSERM U-698, 16 rue Henri-Huchard - B.P. 416, 75877 Paris Cedex 18, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), 20 rue Leblanc, 75015 Paris, France
| | - Jean Ferrières
- Department of Cardiology, Centre Hospitalier Universitaire Rangueil, 2 Rue Charles Viguerie, 31300 Toulouse, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - Tabassome Simon
- Department of Cardiology B and Epidemiology, Toulouse University Hospital, UMR INSERM 1027, 2 Rue Charles Viguerie, 31300 Toulouse, France
| | - Nicolas Danchin
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), 20 rue Leblanc, 75015 Paris, France
- Department of Cardiology, Hôpital Paris St Joseph, 285 rue Raymond Losserand, 75014 Paris, France
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Papathanasiou KA, Rallidis SL, Armylagos S, Kotrotsios G, Rallidis LS. Gender Differences Among Very Young Patients With Acute Coronary Syndrome: Long-Term Follow-Up of the STAMINA Study. Angiology 2024:33197241232567. [PMID: 38330905 DOI: 10.1177/00033197241232567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The rate of hospitalization for acute coronary syndrome (ACS) among young patients is increasing. Healthcare disparities remain unsolved among female patients. We explored gender differences regarding risk factors, clinical presentation, in-hospital treatment, and long-term outcomes among ACS patients. A total of 445 patients with very early ACS (men ≤ 35 years and women ≤ 40 years of age) were followed for a median of 5 years. Primary clinical endpoint was the composite of cardiac death, non-fatal myocardial infarction, stroke, and coronary revascularization. Women accounted for 16% of cases. Smoking was the most prevalent risk factor, 56% and 60% of the females and males, respectively, continued to smoke after ACS. Chest pain was typical in 85% and 83% of the female and male patients, respectively. In-hospital treatment (pharmacological and reperfusion) as well as the composite clinical endpoint during follow-up did not differ between female and male patients. Lipid-lowering therapy was suboptimal in both genders, and persistence of smoking was the sole predictor for the composite clinical endpoint (hazard ratio: 2.30 [95% CI: 1.26-4.20]; P = .007). In conclusion, in-hospital treatment was similar between male and female patients. However, the majority of them continued smoking, and this was an independent predictor for future adverse outcomes.
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Affiliation(s)
- Konstantinos A Papathanasiou
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Stylianos L Rallidis
- BSc of Biomedical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Stylianos Armylagos
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Georgios Kotrotsios
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Loukianos S Rallidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
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Grave C, Gabet A, Cinaud A, Tuppin P, Blacher J, Olié V. Nationwide time trends in patients hospitalized for acute coronary syndrome: a worrying generational and social effect among women. Eur J Prev Cardiol 2024; 31:116-127. [PMID: 37794752 DOI: 10.1093/eurjpc/zwad288] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023]
Abstract
AIMS To estimate the time trends in the annual incidence of patients hospitalized for acute coronary syndrome (ACS) in France from 2009 to 2021 and to analyse the current sex and social differences in ACS, management, and prognosis. METHODS AND RESULTS All patients hospitalized for ACS in France were selected from the comprehensive National Health Insurance database. Age-standardized rates were computed overall and according to age group (over or under 65 years), sex, proxy of socioeconomic status, and ACS subtype [ST-segment elevation (STSE) and non-ST-segment elevation]. Patient characteristics and outcomes were described for patients hospitalized in 2019. Differences in management (coronarography, revascularization), and prognosis were analysed by sex, adjusting for cofonders. In 2019, 143,670 patients were hospitalized for ACS, including 53,227 STSE-ACS (mean age = 68.8 years; 32% women). Higher standardized incidence rates among the most socially deprived people were observed. Women were less likely to receive coronarography and revascularization but had a higher excess in-hospital mortality. In 2019, the age-standardized rate for hospitalized ACS patients reached 210 per 100 000 person-year. Between 2009 and 2019, these rates decreased by 11.4% (men: -11.2%; women: -14.0%). Differences in trends of age-standardized incidence rate have been observed according to sex, age, and social status. Middle aged women (45-64 years) showing more unfavourable trends than in other age classes or in men. In addition, among women the temporal trends were more unfavourable as social deprivation increased. CONCLUSION Despite encouraging overall trends in patients hospitalized for ACS rates, the increasing trends observed among middle-aged women, especially socially deprived women, is worrying. Targeted cardiovascular prevention and close surveillance of this population should be encouraged.
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Affiliation(s)
- Clémence Grave
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| | - Amélie Gabet
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| | - Alexandre Cinaud
- Centre de diagnostic et de thérapeutique, Hôpital Hôtel-Dieu AP-HP, Université Paris Cité, Paris, France
| | - Philippe Tuppin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale de l'Assurance Maladie, Paris, France
| | - Jacques Blacher
- Centre de diagnostic et de thérapeutique, Hôpital Hôtel-Dieu AP-HP, Université Paris Cité, Paris, France
| | - Valérie Olié
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
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