Women in Scotland were undertreated compared to men after a myocardial infarction, with the odds of receiving medicines that can prevent another myocardial infarction ‘stacked against you’ if you are female, researchers suggest.
The first national study in Scotland to examine the difference in treatment and outcomes between the sexes found that women are less likely to receive medicines that can prevent future myocardial infarction, strokes and cardiovascular complications.
The findings are published in the European Journal of Preventive Cardiology and build on an earlier study by the same authors, which found that following a diagnosis of heart disease, the death rate from cardiovascular causes for women increased relative to that of men.
Myocardial infarction is a leading cause of death and disability around the world, affecting men and women differently. The overall association between a person‘s sex and myocardial infarction outcomes is unclear and could be related to different treatment practices between the sexes in healthcare systems.
The researchers examined the treatment and outcome of 15,776 women and 31,287 men admitted to hospital after a myocardial infarction across Scotland between 2010 and 2016. Outcomes in the hospital were analysed according to rates of percutaneous coronary intervention, secondary prevention and mortality.
Each patient was followed for an average of eight years post-hospital discharge until the end of 2021, and rates of cardiovascular mortality and new cardiovascular events were monitored.
The researchers compared the findings to 81,341 matched healthy people without heart disease.
The study found that women were 13% less likely to undergo percutaneous coronary intervention and 6% less likely to undergo cardiac catheterisation than men whilst they were in hospital. Women were also 9% less likely to receive preventative treatments such as statins, beta-blockers or antiplatelets over the follow-up period.
Overall, female patients had lower long-term death rates in comparison to men, but the ‘female survival advantage’ – an observation in which women usually live longer than men – was less pronounced in the people with myocardial infarction.
The researchers found no significant differences in areas across Scotland, but sex differences were more pronounced in deprived areas.
Dr Tiberiu Pana, honorary early career clinical research fellow at the University of Aberdeen, who led the study, said: ‘Our results confirm the presence of important sex differences amongst Scottish heart attack patients. This important finding should guide patients and doctors to work together to improve prescription uptake and compliance with recommended preventative treatments to reduce the burden of heart disease in our population.
Dr Pana emphasised the need to improve the long-term outcomes of women after myocardial infarction, but the researchers also found that treatment for men could also be improved.
Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation and consultant cardiologist, said it was important that existing evidence-based treatments reach both men and women.
But, she added: ‘Time and time again, data show that the odds of receiving medicines that can prevent another heart attack, or a future stroke appear stacked against you if you are a woman. Solving why, including by redressing system and society biases, could help more women in Scotland and other countries live in good health for longer.’
In May 2024, a study revealed that cholesterol-lowering drugs are less frequently prescribed to women compared to men, despite European Society of Cardiology guidelines recommending statins for all patients with chronic coronary syndrome.
A version of this article was originally published by our sister publication Nursing in Practice.
