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. 2024 Nov 11;31(15):1850-1860.
doi: 10.1093/eurjpc/zwae255.

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

Orianne Weizman  1   2 , Marie Hauguel-Moreau  2 , Victoria Tea  1 , Franck Albert  3 , Paul Barragan  4 , Jean-Louis Georges  5 , Nicolas Delarche  6 , Mathieu Kerneis  7 , Vincent Bataille  8 , Elodie Drouet  9   10 , Etienne Puymirat  1 , Jean Ferrières  11 , François Schiele  12 , Tabassome Simon  8 , Nicolas Danchin  1   13 ; FAST-MI Investigators
Collaborators, Affiliations

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

Orianne Weizman et al. Eur J Prev Cardiol. .

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.

Keywords: Coronary artery disease; Lipid-lowering therapy; Myocardial infarction; Sex; Statins.

Plain language summary

Lipid-lowering therapy (LLT) is under-prescribed in women after acute myocardial infarction (AMI). Whether this difference persists over time and influences long-term outcomes is unclear. Women still suffer from insufficient prescription of high-intensity LLT at discharge after an AMI, even in the most recent years of the study, with a 5 year survival significantly reduced in women who did not receive high-dose LLT Propensity score matched analysis showed similar results on survival and cardiovascular events.

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Conflict of interest statement

Conflict of interest: N.D. has received personal fees and non-financial support from Amgen, AstraZeneca, Bayer, BMS, Sanofi, personal fees from Boehringer Ingelheim, Intercept, MSD, Novo Nordisk, Pfizer, Servier, UCB Pharmaceuticals, and Vifor, all outside the submitted work. E.P. reports fees for lectures and/or consulting: Amgen, AstraZeneca, Bayer, Biotronik, BMS, Boehringer Ingelheim, Daiichi Sankyo, Lilly, MSD, The Medicine Company, Sanofi, Saint Jude Medical, Servier, Siemens. J.F. reports speaking fees for Amgen, Sanofi, Servier and MSD. F.S. reports personal fees from Amgen, AstraZeneca, Bayer, BMS, MSD, Pfizer, and Sanofi, outside the submitted work. T.S. reports grants from AstraZeneca, Daiichi Sankyo, Eli-Lilly, GSK, MSD, Novartis, Sanofi, and personal fees for board membership and/or consultancy and/or lectures from AstraZeneca, BMS, Sanofi, and Novartis. J.-L.G. reports personal fees for lectures and/or consulting: Amgen, MSD, Novartis, and Sanofi-Winthrop France.

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