Gender Differences in Heart Attack Survivors

Female heart attack patients less likely than men to initiate, take prescribed medications

(RxWiki News) Heart attack survivors are routinely prescribed a cocktail of medications to prevent another cardiac event. But for young women, the situation may be a bit more complicated.

A new study from the University of British Columbia (UBC) in Canada found that young women may be less likely than young men to initiate and refill their medications as directed after a heart attack.

"The gender gap in treatment initiation among younger women is an important finding because younger women have much worse outcomes after suffering a heart attack than do men of the same age," said study co-author Karin Humphries, DSc, an associate professor of cardiology at UBC, in a press release. "This finding suggests that younger women should be treated aggressively, especially when we have medications that work."

Sarah A. Samaan, MD, a board-certified cardiologist and physician partner with The Heart Hospital Baylor Plano, gave RxWiki News a few reasons why women might be less likely to have their prescriptions filled after a heart attack.

"Women often minimize their symptoms, or convince themselves and others that everything is OK when in fact it is not," Dr. Samaan said. "As a result, they may be less inclined to fill prescriptions for medication after a heart attack. In addition, it is more common for a married man to have a spouse that serves a care-giving role, encouraging her husband to take his medications and get the prescriptions filled. For women living with heart disease, their male spouses are probably less likely to take on this care-giving responsibility."

According to Dr. Humphries and colleagues, both men and women are recommended to take ACE inhibitors (to improve blood flow), beta-blockers (to slow the heart) and statins (to reduce cholesterol levels) after a heart attack to reduce the risk of another cardiac event.

"ACE inhibitors can be problematic in women of child-bearing age," Dr. Samaan said. "If a woman is on one of these drugs and becomes pregnant, then the drugs can be toxic to the baby’s developing kidneys. That may be one reason that doctors are reluctant to prescribe these drugs to younger women. In addition, women often run lower blood pressures, which may limit the ability to prescribe drugs that can lower blood pressure further."

Past research has found that rates of medication use after a heart attack are lower among women than men.

"There are two possible reasons why women take fewer cardiovascular medications than men in an outpatient setting," said lead study author Kate Smolina, PhD, a postdoctoral fellow in pharmacoepidemiology and pharmaceutical policy at the University of British Columbia, in a press release. "It is either a consequence of physicians’ prescribing behavior, or patients not taking their prescribed medication, or both."

For this study, Dr. Smolina and team looked at more than 12,000 Canadian patients between 2007 and 2009 who survived for at least one year after a heart attack.

After leaving the hospital, only one-third of these patients filled their prescriptions as recommended for at least 80 percent of the following year.

Only 65 percent of women age 55 or younger initiated their treatment on all appropriate drugs post-heart attack, compared to 75 percent of men in the same age group.

No differences were found between men and women in treatment adherence. In other words, once on therapy, both men and women continued or discontinued it at the same rates.

Dr. Smolina and team concluded by calling for more focus on the treatment of young women after a heart attack.

"It is important for both physicians and patients to move away from the traditional thinking that heart disease is a man's disease," Dr. Smolina said. "Heart disease in young women has only recently received research attention, so it is possible that physicians and patients still have the incorrect perception that these heart medications pose risks to younger women."

These researchers recommended that patients ask their doctors if they have been prescribed the medications known to benefit heart attack survivors, keep themselves informed and take all of their medication as directed.

"Heart disease kills more women than all causes of cancer combined, including breast cancer, yet it tends to be underplayed in the press and popular media," Dr. Samaan said. "Women tend to get to the hospital hours later into a heart attack than do men. It’s been shown that part of the reason for this difference is due to the role the spouse plays in recognizing the importance of the symptoms. And since at least 75 percent of heart disease is preventable in the first place, it’s critical that the message gets out loud and clear to women, their families and their physicians."

This study was published Oct. 13 in the journal Circulation: Cardiovascular Quality and Outcomes.

The Canadian Institutes of Health Research funded this research.

No conflicts of interest were disclosed.

Review Date: 
October 13, 2015