Sex Differences in Pharmacologic Optimal Medical Therapy for Ischemic Heart Disease

BACKGROUND: Despite guideline recommendations for optimal medical therapy (OMT) for ischemic heart disease (IHD), sex disparities in pharmacologic treatment remain poorly characterized in recent years. OBJECTIVES: The objective of the study was to examine sex differences in the use and trends of guideline-recommended OMT among adults with IHD in the United States from 2011 to 2020. METHODS: We performed a serial cross-sectional analysis using nationally representative data from the 2011 to 2020 National Health and Nutrition Examination Survey. Adults aged ≥18 years with self-reported IHD were included. OMT was defined as the use of antiplatelets, statins, β-blockers, and renin-angiotensin-aldosterone system inhibitors (RAASi). We examined differences in medication use by sex and evaluated temporal trends stratified by age (<50 vs ≥ 50 years), adjusting for sociodemographic and clinical factors. RESULTS: Among 1,905 adults with IHD (40.6% women; mean age 65.4 years), women were significantly less likely than men to receive antiplatelets (68.0% vs 77.7%), statins (57.2% vs 73.9%), RAASi (45.6% vs 59.0%), and OMT combinations including all 4 medications (17.5% vs 32.5%). These differences remained after multivariable adjustment, particularly for statins (adjusted OR: 0.62; 95% CI: 0.40-0.96) and RAASi (adjusted OR: 0.56; 95% CI: 0.38-0.84). Sex disparities were most pronounced among adults under 50 years, with slower increases in OMT uptake over time among women. CONCLUSIONS: From 2011 to 2020, women, particularly younger women, remained less likely than men to receive guideline-directed OMT for self-reported IHD. These findings underscore the need for policy and practice interventions to improve equitable treatment in cardiovascular disease.