Gender Difference in Secondary Prevention of Cardiovascular Disease and Outcomes Following the Survival of Acute Coronary Syndrome

Heart Lung Circ. 2021 Jan;30(1):121-127. doi: 10.1016/j.hlc.2020.06.026. Epub 2020 Sep 2.


Background: Previous studies have shown that women with acute coronary syndrome (ACS) are less likely to receive in-hospital care such as revascularisation procedures and secondary prevention medications. Therefore, the aim was to determine if the rate of secondary preventive care and outcomes also differ by sex in patients with ACS at 6 and 12 months after discharge.

Methods: Of ACS patients recruited from 43 hospitals between 2009 to 2018, 9,283 were discharged alive and followed up at 6 months as part of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE) registry. Multivariable logistic regression models within the framework of generalised estimating equations were used to compare the rate of medication use, smoking, cardiac rehabilitation participation, major adverse cardiovascular event (MACE: myocardial infarction, heart failure or stroke) and all-cause death at 6 and 12 months after discharge between female and male patients.

Results: Of 9,283 ACS patients, 2,676 (29%) were women. At 6-month post discharge, women were more likely to have comorbidities than men. After adjusting for clinical characteristics, women had lower odds of attending cardiac rehabilitation than men (OR [95% CI]: 0.87 [0.78, 0.98]) and no sex difference in the odds of using ≥75% of the indicated medications or smoking. Women had higher odds of having a MACE compared to men (1.35 [1.03, 1.77]) but there was no difference for all-cause death between women and men. Moreover, at 12 months after discharge, women were less likely to be on ≥75% of the indicated medications (0.84 [0.75, 0.95]) but no difference was found in the odds of smoking, MACE and all-cause death.

Conclusion: Our findings from a large contemporary Australian registry dataset suggest that women attend cardiac rehabilitation programs less often and are more likely to have a MACE at 6 months of surviving ACS. At 12 months post discharge, women were less likely to use the indicated secondary prevention medications. Development of effective secondary prevention methods tailored to women are needed.

Keywords: Acute coronary syndrome; Cardiac rehabilitation; Cardiovascular outcomes; Secondary prevention; Sex.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Acute Coronary Syndrome / mortality
  • Aged
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • New South Wales / epidemiology
  • Prognosis
  • Prospective Studies
  • Secondary Prevention / methods*
  • Sex Distribution
  • Sex Factors
  • Survival Rate / trends