Medication Adherence After Acute Coronary Syndrome in Women Compared With Men: A Systematic Review and Meta-Analysis

Sophie H Bots, Jose A Inia, Sanne A E Peters, Sophie H Bots, Jose A Inia, Sanne A E Peters

Abstract

Introduction: Pharmacological treatment is an important component of secondary prevention in acute coronary syndrome (ACS) survivors. However, adherence to medication regimens is often suboptimal, reducing the effectiveness of treatment. It has been suggested that sex influences adherence to cardiovascular medication, but results differ across studies, and a systematic overview is lacking. Methods: We performed a systematic search of PubMed and EMBASE on 16 October 2019. Studies that reported sex-specific adherence for one or more specific medication classes for ACS patients were included. Odds ratios, or equivalent, were extracted per medication class and combined using a random effects model. Results: In total, we included 28 studies of which some had adherence data for more than one medication group. There were 7 studies for angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) (n = 100,909, 37% women), 8 studies for antiplatelet medication (n = 37,804, 27% women), 11 studies for beta-blockers (n = 191,339, 38% women), and 17 studies for lipid-lowering medication (n = 318,837, 35% women). Women were less adherent to lipid-lowering medication than men (OR = 0.87, 95% CI 0.82-0.92), but this sex difference was not observed for antiplatelet medication (OR = 0.95, 95% CI 0.83-1.09), ACEIs/ARBs (OR = 0.95, 95% CI 0.78-1.17), or beta-blockers (OR = 0.97, 95% CI 0.86-1.11). Conclusion: Women with ACS have poorer adherence to lipid-lowering medication than men with the same condition. There are no differences in adherence to antiplatelet medication, ACEIs/ARBs, and beta-blockers between women and men with ACS.

Keywords: acute coronary syndome; cardiovasccular medicine; medication adherence; sex differences; women.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Bots, Inia and Peters.

Figures

Figure 1
Figure 1
PRISMA 2009 Flow Diagram.
Figure 2
Figure 2
Meta-analysis of unadjusted odds ratios per medication category. (A) Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. (B) Anti-platelet medication. (C) Beta-blockers. (D) Lipid-lowering medication.
Figure 3
Figure 3
Meta-analysis of adjusted odds ratios per medication category. (A) Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. (B) Anti-platelet medication. (C) Beta-blockers. (D) Lipid-lowering medication.
Figure 4
Figure 4
Funnel plot for each medication category. (A) Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. (B) Anti-platelet medication. (C) Beta-blockers. (D) Lipid-lowering medication.

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