Management of Dyslipidemia in Women and Men with Coronary Heart Disease: Results from POLASPIRE Study

Sex Differences in Low-Density Lipoprotein Cholesterol Treatment Among Young Israeli Patients Following Premature Acute Coronary Syndrome

Introduction: Effective management of dyslipidemias is crucial for reducing morbidity and mortality among patients after acute coronary syndrome (ACS). Sex differences in dyslipidemia management after premature ACS in Israeli patients have not been extensively studied. This study aimed to investigate potential disparities between men and women in managing dyslipidemia, considering current guidelines. Methods: This retrospective cohort study examined patients who were 55 years old or younger and admitted to Meir Medical Center for ACS from January 2018 to February 2019. The study aimed to evaluate the use of lipid-lowering therapy (LLT), measure the achievement of target low-density lipoprotein cholesterol (LDL-C) levels, and analyze the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in both male and female patients. Results: The study included a total of 687 participants, of which 23.3% were identified as females. Upon discharge, ∼80% of the patients were prescribed high-intensity statins. After 1 year, it was observed that females had higher levels of LDL-C and lower rates of achieving target LDL-C levels (<70 and 55 mg/dL) as compared with males (45% vs. 54.6% and 30% vs. 42.2%, respectively). The use of non-statin LLT at the 1-year mark was minimal in both groups. Finally, it was found that the occurrence of MACCE was similar between males and females. Conclusion: Sex disparities in dyslipidemia management after a premature ACS were apparent, with females having higher LDL-C levels and lower rates of target achievement. Intervention is necessary to address these disparities and encourage greater use of non-statin LLT.

Gender inequalities in secondary prevention of cardiovascular disease: a scoping review

BACKGROUND

Despite significant progress in cardiovascular disease (CVD) management, it remains a public health priority and a global challenge. Within the disease process, health care after a cardiovascular event (secondary prevention) is essential to prevent recurrences. Nonetheless, evidence has suggested the existence of gender disparities in CVD management, leaving women in a vulnerable situation. The objective of this study is to identify all available evidence on the existence of gender differences in health care attention after a major adverse cardiovascular event.

METHODS

A scoping review following the structure of PRISMA-ScR was conducted. To define the inclusion criteria, we used Joanna Briggs Institute (JBI) population, concept, context framework for scoping reviews. A systematic search was performed in MEDLINE (PubMed), EMBASE and Cochrane. The methods of this review are registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) (INPLASY202350084).

RESULTS

The initial search retrieved 3,322 studies. 26 articles were identified manually. After the reviewing process, 93 articles were finally included. The main intervention studied was the pharmacological treatment received (n = 61, 66%), distantly followed by guideline-recommended care (n = 26, 28%) and cardiac rehabilitation (CR) referral (n = 16)". Literature described gender differences in care and management of secondary prevention of CVD. Women were less frequently treated with guideline-recommended medications and seem more likely to be non-adherent. When analysing guideline recommendations, women were more likely to make dietary changes, however, men were more likely to increase physical activity. Studies also showed that women had lower rates of risk factor testing and cholesterol goals attainment. Female sex was associated with lower rates of cardiac rehabilitation referral and participation.

CONCLUSIONS

This review allowed us to compile knowledge on the existence of gender inequalities on the secondary prevention of CVD. Additional research is required to delve into various factors influencing therapeutic disparities, referral and non-participation in CR programs, among other aspects, in order to improve existing knowledge about the management and treatment of CVD in men and women. This approach is crucial to ensure the most equitable and effective attention to this issue.

Trends and Disparities in Treatment and Control of Atherosclerotic Cardiovascular Disease in US Adults, 1999 to 2018

BACKGROUND

Although cardiovascular mortality continued declining from 2000 to 2019, the rate of this decrease decelerated. We aimed to assess the trends and disparities in risk factor control and treatment among US adults with atherosclerotic cardiovascular disease to find potential causes of the deceleration.

METHODS AND RESULTS

A total of 55 ,021 participants, aged ≥20 years, from the 1999 to 2018 National Health and Nutrition Examination Survey were included, of which 5717 were with atherosclerotic cardiovascular disease. Risk factor control was defined as hemoglobin A1c <7%, blood pressure <140/90 mm Hg, and non-high-density lipoprotein cholesterol <100 mg/dL. The prevalence of atherosclerotic cardiovascular disease oscillated between 7.3% and 8.9% from 1999 to 2018. A significant increasing trend was observed in the prevalence of diabetes, obesity, heavy alcohol consumption, and self-reported hypertension within the population with atherosclerotic cardiovascular disease (Ptrend≤0.001). Non-high-density lipoprotein cholesterol <100 mg/dL increased from 7.1% in 1999 to 2002 to 15.7% in 2003 to 2006, before plateauing. Blood pressure control (<140/90 mm Hg) increased until 2011 to 2014, but declined to 70.1% in 2015 to 2018 (Ptrend<0.001, Pjoinpoint=0.14). Similarly, the proportion of participants achieving hemoglobin A1c control began to decrease after 2006 (Pjoinpoint=0.05, Ptrend=0.001). The percentage of participants achieving all 3 targets increased significantly from 4.5% to 18.6% across 1999 to 2018 (Ptrend=0.02), but the increasing trend decelerated after 2005 to 2006 (Pjoinpoint<0.001). Striking disparities in risk factor control and medication use persisted between sexes, and between different racial and ethnic populations.

CONCLUSIONS

Worsened control of glycemia, blood pressure, obesity, and alcohol consumption, leveled lipid control, and persistent socioeconomic disparities may be contributing factors to the observed deceleration in decreasing cardiovascular mortality trends.

Sex Differences in Repolarization Markers: Telemonitoring for Chronic Heart Failure Patients

Aging and chronic heart failure (CHF) are responsible for the temporal inhomogeneity of the electrocardiogram (ECG) repolarization phase. Recently, some short period repolarization-dispersion parameters have been proposed as markers of acute decompensation and of mortality risk in CHF patients. Some important differences in repolarization between sexes are known, but their impact on ECG markers remains unstudied. The aim of this study was to evaluate possible differences between men and women in ECG repolarization markers for the telemonitoring of CHF patients.

METHOD

5 min ECG recordings were collected to assess the mean and standard deviation (SD) of the following variables: QT end (QTe), QT peak (QTp), and T peak to T end (Te) in 215 decompensated CHF (age range: from 49 to 103 years). Thirty-day mortality and high levels of NT-pro BNP (<75 percentile) were considered markers of decompensated CHF.

RESULTS

A total of 34 patients (16%) died during the 30-day follow-up, without differences between sexes. Women showed a more preserved ejection fraction and higher LDL and total cholesterol levels. Among female patients, implantable cardioverter devices, statins, and antiplatelet agents were less used. Data for Te mean showed increased values among deceased men and women compared to survival, but Te_SD was shown to be the most reliable marker for CHF reacutization in both sexes.

CONCLUSION

Te_SD could be considered a risk factor for CHF worsening and complications for female and male patients, but different cut offs should be taken into account. (ClinicalTrials.gov number, NCT04127162.).

Exploring Contemporary Data on Lipid-Lowering Therapy Prescribing in Patients Following Discharge for Atherosclerotic Cardiovascular Disease in the South of Italy

Current international guidelines strongly recommend the use of high-intensity lipid-lowering therapy (LLT) after hospitalization for atherosclerotic cardiovascular disease (ASCVD) events. With this study, our aim was to evaluate LLT prescribing in a large Italian cohort of patients after discharge for an ASCVD event, exploring factors associated with a lower likelihood of receiving any LLT and high-intensity LLT. Individuals aged 18 years and older discharged for an ASCVD event in 2019-2020 were identified using hospital discharge abstracts from two local health units of the Campania region. LLT treatment patterns were analyzed in the 6 months after the index event. Logistic regression models were developed for estimating patient predictors of any LLT prescription and to compare high-intensity and low-to-moderate-intensity LLT. Results: A total of 8705 subjects were identified. In the 6 months post-discharge, 56.7% of patients were prescribed LLT and, of those, 48.7% were high-intensity LLT. Female sex, older age, and stroke/TIA or PAD conditions were associated with a higher likelihood of not receiving high-intensity LLT. Similar predictors were found for LLT prescriptions. LLT utilization and the specific use of high-intensity LLT remain low in patients with ASCVD, suggesting a substantial unmet need among these patients in the contemporary real-world setting.

Demographics and Characteristics of Patients Admitted With Acute Coronary Syndrome to the Coronary Care Unit at King Abdulaziz University

Background Over the previous decade, the incidence of cardiovascular diseases (CVDs) has risen in the Middle East and will increase mortality to 23 million individuals in Saudi Arabia by 2030, according to the Saudi Ministry of Health. CVDs, including acute coronary syndrome (ACS), are the most common cause of mortality globally. This study aimed to analyze the demographic and clinical characteristics of patients with ACS admitted to the coronary care unit (CCU) in a tertiary hospital in Jeddah, Saudi Arabia. To the best of our knowledge, a lack of research in this region has been undertaken. Methods This retrospective records review study was conducted in a tertiary center in Jeddah, Saudi Arabia. All patients admitted to our CCU in 2017 with a final diagnosis of ACS were retrospectively enrolled. Demographic details, coronary risk factors, investigation and procedures, management, and clinical outcomes are all part of the data. Results Of the 615 patients included in the study, 491 (79.84%) were males, 226 (36.75%) were 55-64 years old, and 161 (26.18%) were 45-54 years old. Males had a higher rate of ST-segment elevation myocardial infarction (STEMI) (214, 43.58%), while females had a higher rate of non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA) (45.96% and 37.90%, respectively). Diabetes (62.60%), dyslipidemia (62.44%), and hypertension (61.46%) were the most prevalent risk factors. Angiography and percutaneous coronary intervention (PCI) were performed in 77.72% and 61.95% of patients, respectively. Coronary artery bypass graft was only performed in 4.39% of patients. PCI was performed more frequently in patients with STEMI than in those with NSTEMI/UA (P < 0.001). A large majority of patients (99.5%) recovered and were discharged. Of the 161 (26.18%) patients who attended a follow-up visit, only 45 (33.08%) met the therapeutic objective of 1.8 mmol/L (70 mg/dl) of low-density lipoprotein cholesterol. There were 100 (16.26%) patients readmitted to the CCU, and most of these were readmitted within a year after initial admission. Readmissions were more common in females and patients diagnosed with NSTEMI/UA during initial admission (15.47% and 19.35%, respectively). Conclusion This study revealed that our most common demographics were males between 45 and 64 years, which is a decade younger than the global average. STEMI was the most common presentation. The most common modifiable cardiovascular risk factors were hypertension, diabetes, and dyslipidemia. The most common adverse event was reinfarction, which was closely linked to hypertension and diabetes. In this study, the recovery rate was higher than in studies from other countries; however, the majority of patients did not achieve the goal of cholesterol levels at follow-up. Our population's younger age at presentation necessitates greater attention and more stringent preventive strategies, such as lifestyle changes and evidence-based treatments for CVD risk factors, to reduce the incidence and burden of ACS on CCUs.

Recollection of Physician Information about Risk Factor and Lifestyle Changes in Chronic Coronary Syndrome Patients

A patient’s compliance to a physician’s lifestyle information is essential in chronic coronary syndrome (CCS) patients. We assessed potential characteristics associated with a patient’s recollection of physician information and lifestyle changes. This study recruited and interviewed patients (aged ≤ 80 years) 6–18 months after hospitalization due to acute coronary syndrome or elective myocardial revascularization. A physician’s information on risk factors was recognized if patients recollected the assessment of their diet, weight management, blood pressure control, cholesterol level, diabetes, and other lifestyle factors by the doctor. Of a total of 946 chronic coronary syndrome patients, 52.9% (501) of them declared the recollection of providing information on more than 80% of the risk factors. A good recollection of risk factor information was associated with the following: a patient’s age (OR per year: 0.97; 95% CI: 0.95 to 0.99), obesity (OR: 4.41; 95% CI: 3.09–6.30), diabetes (OR: 4.16; 95% CI: 2.96–5.84), diuretic therapy (OR: 1.41; 95% CI: 1.03–1.91), calcium channel blockers (OR: 1.47; 95% CI: 1.04–2.09), and ACEI/sartan (OR: 0.65; 95% CI: 0.45–0.94) at hospitalization discharge. In terms of goal attainment, better adherence to antihypertensive drugs (OR: 1.80; 95% CI: 1.07–3.03) was observed in the patients with a good compared to a poor recollection of risk factor information. The recollection of physician risk factor information was significantly associated with more comorbidities. Strategies to tailor the conveying of information to a patient’s perception are needed for optimal patient–doctor communication.