SPC365

Sex disparities in lipid-lowering therapy and dyslipidemic control in a Coronary Rehabilitation Program

Session: Posters (Sessão 1 - Écran 3) - Doença Cardiovascular em Populações Especiais 1
Speaker: Tânia Proença

Congress: CPC 2022
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.2 Cardiovascular Disease in Women
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Tânia Proença; Ricardo Alves; Miguel Martins Carvalho; Catarina Costa; Filipa Amador; João Calvão; André Cabrita; Catarina Marques; Carlos Xavier Resende; Pedro Diogo; Sofia Torres; Joana Rodrigues; Vitor Araujo; Paula Dias; Filipe Macedo

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-size:12.0pt">Introduction:</span></strong><span style="font-size:12.0pt"> Lipid control is one of the most important secondary cardiovascular prevention targets. Although cardiovascular disease is the most common cause of death for both sexes, several studies have consistently shown that women </span><span style="font-size:12.0pt">are less likely to receive guideline-recommended secondary prevention medications after an acute coronary syndrome (ACS). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-size:12.0pt">Purpose</span></strong><span style="font-size:12.0pt">: </span><span style="font-size:12.0pt">To compare sex disparities in dyslipidemic control in a secondary prevention population with ACS in light of the ESC Dyslipidemia Guidelines.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-size:12.0pt">Methods: </span></strong><span style="font-size:12.0pt">We retrospectively analysed all patients </span><span style="font-size:12.0pt">who participated in a Coronary Rehabilitation Program (CRP) after an ACS from January 2011 to October 2019. Clinical data was collected at presentation and during 12 months follow-up. Doses of atorvastatin &ge; 40 mg, rosuvastatin &ge; 20 mg or a combination of a statin and ezetimibe were considered high-intensity LDL-lowering therapy (HIT).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-size:12.0pt">Results: </span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="font-size:12.0pt">Of a total of 881 patients enrolled, mean age 55.0 </span><span style="font-size:12.0pt"><span style="font-family:Symbol">&plusmn;</span></span><span style="font-size:12.0pt"> 10.0 year-old, 16.1% were female. At baseline there were no differences respecting clinical features between genres. 51.4% of patients had ST-elevation myocardial infarction. </span><span style="font-size:12.0pt">63% patients had dyslipidemia, 46% had hypertension, 19% were diabetic, 76% were smokers or previous smokers, 27% had family history of coronary disease and 12% had previous coronary disease (ACS or &gt;50% coronary artery stenosis). At hospital admission, females and males had similar mean LDL-levels [120.7 vs 118.1 mg/dL, t(708)=0.691, p=0.496]. The vast majority of patients of both genres were discharged on statin (99.5%) and maintain it during follow-up (99.3%). Female patients received more HIT during follow-up (67.8% vs 53.9% at baseline, p=0.015; 75.6% vs 59.0% after CRP, p=0.003; and 79.8% vs 65.1% at 1-year-follow-up, p=0.007). &nbsp;During follow-up, at the end of the CRP (about 3 months after event), male exhibit a better control of LDL [82.0 vs 75.6 mg/dL, t(597)=2.4, p=0.016)] with 12.8% vs 16.4% below 55 mg/dL and 29.8% vs 44.5% below 70 mg/dL (p=0.008). At 1-year follow-up, both genres exhibited similar LDL-control thanks to a worsening control of male population (81.9 vs 80.6 mg/dL, t(540)=0.52, p=0.605). Only 13.3% of females had LDL below 55 mg/dL (vs 12.9%, p=0.921) and 32.5% below 70 mg/dL (vs 37.0%, p=0.432). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-size:12.0pt">Conclusion: </span></strong><span style="font-size:12.0pt">This real life study showed that guideline recommended LDL target is not achieved in the majority of patients even under </span><span style="font-size:12.0pt">a structured CRP</span><span style="font-size:12.0pt">. Unlike to other reports, women received more potent anti-dyslipidemic therapy. Nevertheless, they showed a poor control of LDL-concentration after three months of ACS and a similar control after 1-year; this highlights the u</span><span style="font-size:12.0pt">ncertainties related to the efficacy of lipid-lowering therapy in women, a underrepresented population in clinical trials.</span></span></span></p>