Prognostic impact of high-intensity lipid-lowering therapy under-prescription after acute myocardial infarction in women

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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Publication Details

Journal
European Journal of Preventive Cardiology
Published
2024-08-05
DOI
https://doi.org/10.1093/eurjpc/zwae255
Citations
6
Primary Topic
Lipoproteins and Cardiovascular Health
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article
Field-Weighted Citation Impact
3.44

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article

Prognostic impact of high-intensity lipid-lowering therapy under-prescription after acute myocardial infarction in women

F Schiele, P Djiane, Hanna Garnier, Patrick Peycher et al.
6 citations
European Journal of Preventive Cardiology
Lipoproteins and Cardiovascular Health
3.44
article

Prognostic impact of high-intensity lipid-lowering therapy under-prescription after acute myocardial infarction in women

F Schiele, P Djiane, Hanna Garnier, Patrick Peycher, D Rondepierre, Eric Decoulx, Petra Jessen, P Boulard, P Cornec, P Dambrine, Olivier Nugue, Bertrand Mettauer, B Estampes, Nicolas Marque, Laure Hammer, J Rouffaud, Judite Blanc, Bernadette Chevalier, P Bickert, Vincent Decourcelle, Étienne Puymirat, Guillaume Taldir, Sophie Godard, A Koegler, D Grison, B Valeix, E Pierre-Justin, J Elaerts, G Pacouret, A Muligo, Y Beauverger, G Trémeau, G. Amat, Jean‐Luc Puel, M-C Palcoux, Pervez Sultan, Asmae Bettioui, Vincent Descotes‐Genon, Amer N. Kadri, J Becquart, G Traisnel, J Morice, P Y Petiteau, Jean-Yves Pagny, A. Luycx-Bore, A Coeurderoy, R Benderbous, P Graux, E Dadez, Olivier Dibon, Pascal Guyon, Karl Isaaz, Simon Cattan, H Benamer, C. Gully, J. L. Bourdon, Laurent Schmutz, F. Duclos, Olivier de Tauriac, Christophe Tron, Eduardo Kaiser Ururahy Nunes Fonseca, Jean Ferrières, C Barnay, Mamy Andriambololona, Lyassine Nait Saidi, L Genet, C Boureux, Raphaël Poyet, Stanislas Champin, Y Lefrancois, X Tabone, Élodie Drouet, J.P. Godenir, Jacques Monségu, G. Jarry, H. Le Bris, J M Demarcq, Camille Le Ray, Vincent Bataille, Bruno Vahdat, P Guéret, B Peltier, G Baradat, François Schiele, F. Saint-Pierre, G Convert, M Baudouy, Hassan Saadouni, J. Grebet, Philoktimon Plastaras, B. Ritz, Joan DuPont, Flavia Soto, Gilles Rouault, M Francoual, B Beaudet, Gilles Dentan, G Baulleret, Jean Luc Banos, A Scemama, P. Wyart, Mohamed Gasmi, Emmanuel Salengro, Karim Moussa, Guy Legros, M Slama, Nicolas Danchin, Meyer Elbaz, François P. Thieuleux, C Gueniche, Gilles Lemesle, Irina Oltean, M Coco, Alain Dibié, G. Roul, François Raoux, Philippe Beaufils, Gaston Rébuffat, Victoria Tea, J Coupillaud, J Ponsonnaille, Farzin Beygui, J Souk Aloun, Régis Deturck, D Flammang, R Pillière, P. Loiselet, M N Dulhoste, H Jambert, Patrick Assayag, F Philippe, A Bineau-Jorisse, Hélène Aelion, Jacques Hugon, P Baudouy, Thierry Lefèvre, D Heiligenstein, C Goburdhun, Ziad Boueri, Franck Digne, Jérémie Bourdon, Olivier Dubourg, C. Chaussard, Luc Michel, Coralie Lemoine, P. Meimoun, F. Walylo, Christophe Robin, Philippe Hochart, M Pailloncy, Eric Maupas, B Lancelin, O. Claudon, Vidal Haddad, J M Paemelaère, Dominique Magnin, Richard Megbemado, Pierre François Lesault, Jean-Claude Dib, M Viallet, Patrick Bert-Marcaz, J. M. Perron, Didier Carrié, D. Broucqsault, Jean Yves Wiedemann, A Verdun, Johanne Silvain, Jean-Jacques Dujardin, P Pruvost, P Henry, Alexis Cerisier, Didier Blanchard, Franck Paganelli, M. Hanssen, Jean Armengaud, L Sarfati, B. d’Hautefeuille, Gaël Latour, D Vilarem, Angelika Zabel, M Pichène, C Milon, Danièle Pacaud, Jean‐Pierre Bassand, A Héraudeau, Nicolas Delarche, Pierre Meyer, M Lescure, R Roche, B Harbaoui, G Pochmalicki, Denis Angoulvant, Brahim Baala, Élodie Faure, Paul Bernard, B Popovic, Christophe Breton, Pierre‐Louis Bazin, Simon Elhadad, Mika Laine, Paul Barragan, P Aouate, Jean Fajadet, S. Sedighian, Guillaume Leurent, X. Marcaggi, Richard Schultz, P Druelles, Stéphane Gréciano, Jean Baptiste Landel, P Fichter, P Messner-Pellenc, J Bardet, S Onceanu, J Dewilde, Didier Champagnac, Fabiano Di Marco, Denis Baborier, Jean Philippe Doazan, Nicolas Ley, Bernard Karsenty, R Sader, C Mycinski, Victor Aboyans, G Courdier, S. Perrot, Ryad Bourkaïb, Bruno Huret, P Bareiss, S. Cazaux, Aurélien Boré, Christian Godreuil, O Guenot, Matthias Läng, Nathalie Duvilla, Marie Bienvenu, Florence Durup, Djamel Hamani, J. Darchis, M Escande-Orthlieb, G Lapeyre, Shamili Allam, Gabriel Napporn, Abdourahmane Diallo, G Coatantiec, Jean-Philippe Elkaïm, S. Destrac, Antoine Gommeaux, Sarah Ledon, Etienne Coz, A Cribier, François Tarragano, P Rumeau, Olivier Darremont, P Airaud, Djamel Saouli, Philippe Hénon, X. F. Faverau, H Escojido, Fatima Bouriche, M Fourdilis, Stefan Weber, Thibaud Meurice, Jean Litalien, G Allard-Latour, F. De Poli, L Ledain, Nicolas Mansencal, Philippe Castellant, Akram Chmaït, J Boschat, J Vittrant, Maria Àngels Font, P Quandalle, Tabassome Simon, S Chayeb, Christophe Le Ray, Pierre‐André Cazenave, Jean-Philippe Claudel, Ahmad Shah Farhat, B Herve, Elisabeth Somody, L. Levai, J Allal, T Demichéli, B Charbonnier, J Chounet, R Grossetête, Gilbert Kirkorian, G Cellarier, Ginette Bessède, Marie Hauguel‐Moreau, Philippe Geslin, Alban Le Monnier, M. Mteirek, P Lagorce, V. Simandoux, P Sans, J C Quiret, B Sivery, Norbert Mayaud, P. Schiano, Mathieu Kernéis, B Magdelaine, T Bontemps, Françis Brunelle, Thierry Jullien, Philippe Rioux, C Breut, Jean‐Louis Georges, Régis Delaunay, Pierre Coste, Orianne Weizman, J.C. Kahn, P Boutaud, K. Dumessi, Didier Bresson, E. H. Saadouni, B Carette, J M Montély, Brigitte De Breyne, P Virot, M. Brignon, Paul Coulon, Mathieu Deltreuil, Nicholas D. Poulos, H Lardoux, G Bureau, Olivier Jabourek, Lucas Garcias, B Koujan, P Asseman, J-P Metzger, J L Parola, Laurence Flork, R Huguet, A Bonneau, Virginie Heroguelle, Xavier Favereau, J E Poulard, B. Herce, Olivier Genée, X Lamit, J. Souk-aloun, C. Charbonnel, Patrick Khanoyan, Xavier de Boisgelin, Jean Louis Roynard, Olivier Varenne, Alain Grentzinger, Olive, P Eymerit, Jennifer Scarlet Haas, Abdelkader Belhassane, Pierre Fournier, Florence Moulin, Haya Kamal, Jean-Marie Mossard, P. Rougier, O Gauffre, J-J Halary, H Vergnouix, M Zupan Sihcus, S Gostine, V Rouselle, J-P Mailler, S Taamallah, P Lanteme, A Lassabe, O Poitrineau, G Thourot, T Lognogne, P Cardinaud, J-P Cressens, J-F Ronteix, T-A Tissot, Guillaume Cayla, J Machecourt, Patrick Ohlmann, Gilbert Gosselin, C Richard, Laurent Leborgne, D. Galley, J L Jullien, Ivan Laurent, H. Brunel, L. Maillard, Allen Gabriel, Yves Laurent, Philippe Brunel, F Albert, Jean-Yves Thisse, J. Rémy, B. Farah, Je Noel Labeque, A Vahanian, Franck Albert, Ramin Ravan, J. Schwob, J-J Marier, P Coste, Arnaud Ribier, J P Godenir, J. G. Saal, K Khalifé, Etienne Aliot, P Richard, S Marchand, Joël Sainsous, Riadh Rihani, Thibault Perret, J-M Pernes, James J. Damato, J Berland, Yves Guérin, Z H Haddad, Jean-Christophe Bodart, Hakim Ben Amer, Trevor C. Beard, Patrick Dupouy, G. Vanzetto, A. Faure, J.E. Wolf, Jean‐Pierre Faure, C Toussaint, P Salvá, Patrik Michel, Loïc Belle, Romain Cador, J P Collet, T. Joseph, Pierre Lantelme, Mohammed Ghanem, Nayeli N. López Villa, G. Hannebicque, Y François, L Dutoit, P Pon-Gabrielsen, A Kaaki, Gilles Grollier, J P Monassier, Jean-Louis Marcon, V. Lucke, Alain Mihoubi, D Maes, Juan Guillot, F-X Soto, Cécile Baixas, J Bouvier, U Mischke, L. Baciulescu, F Houeze, A Hidoud, Y Deslandes, T Demichelli, P Chevalevreau, A De Labriole, R Temam, D Tchtchoua, E Delcoux
article en
6 citations

Abstract

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.

European Journal of Preventive CardiologyVol. 31(15)
Inserm (FR), Université Fédérale de Toulouse Midi-Pyrénées (FR), Centre Hospitalier Universitaire de Toulouse (FR), CHU Ambroise Paré (BE), Sorbonne Université (FR), Assistance Publique – Hôpitaux de Paris (FR), Hôpital Européen Georges-Pompidou (FR), Hôpital Saint-Antoine (FR), Centre Hospitalier De Pau (FR), Hôpital André Mignot (FR), Hôpital Paris Saint-Joseph (FR), Centre Hospitalier de Versailles (FR)
Amgen, Eli Lilly and Company, Pfizer, AstraZeneca, Bayer, Sanofi, British Microcirculation Society, Daiichi-Sankyo, Mount Sylvia Diatomite, Société Française de Cardiologie, Servier, Daiichi Sankyo Europe
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Lipoproteins and Cardiovascular Health
3.44
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