Gender Differences in Guideline-Directed Medical Therapy for Cardiovascular Disease Among Young Veterans.
Gender Differences in Guideline-Directed Medical Therapy for Cardiovascular Disease Among Young Veterans.
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DOI：
10.1007/s11606-022-07595-1
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发表时间：
2022-09
影响因子：
5.7
通讯作者：
Haskell, Sally G.
中科院分区：
文献类型：
--
作者：
Dhruva, Sanket S.;Dziura, James;Bathulapalli, Harini;Rosman, Lindsey;Gaffey, Allison E.;Davis, Melinda B.;Brandt, Cynthia A.;Haskell, Sally G.
女性退伍军人患心血管疾病的负担越来越重，包括冠状动脉疾病（CAD）和心力衰竭（HF）。临床实践指南推荐多种药物治疗，可以降低死亡率和不良心血管结局的风险。确定在患有冠心病和心力衰竭的退伍军人中，是否存在按性别划分的指南指导的药物治疗的使用差异。回顾展退伍军人（934，504人; 87.8%男性和129，469人; 12.2%女性）从持久自由行动，伊拉克自由和新黎明返回。在诊断后30天、90天和12个月发生CAD和HF事件的患者中，1级、证据等级A指南指导的药物治疗处方的性别差异。对于CAD，药物包括他汀类药物和抗血小板治疗。对于HF，药物包括β受体阻滞剂和肾素-血管紧张素-醛固酮系统抑制剂。总体而言，女性发生CAD和HF的平均年龄低于男性（平均年龄分别为45.8 vs. 47.7岁，p<0.001; 43.7 vs. 45.4岁，p<0.02）。在诊断为冠心病后的12个月内，与男性相比，女性接受至少一种CAD药物处方的几率为0.85（95%置信区间[CI]，0.68-1.08）。在诊断为HF事件后的12个月内，与男性相比，女性接受至少一种HF药物治疗的几率为0.54（95% CI，0.37-0.79）。尽管有指南的建议，年轻女性退伍军人在诊断为HF后1年内接受指南指导的药物治疗的几率约为一半。这些结果突出表明，需要制定有针对性的战略，以尽量减少心血管疾病护理的性别差异，以防止在这个年轻和不断增长的人口的不良后果。
There is an increasing burden of cardiovascular disease, including coronary artery disease (CAD) and heart failure (HF), among women Veterans. Clinical practice guidelines recommend multiple pharmacotherapies that can reduce risk of mortality and adverse cardiovascular outcomes. To determine if there are disparities in the use of guideline-directed medical therapy by gender among Veterans with incident CAD and HF. Retrospective. Veterans (934,504; 87.8% men and 129,469; 12.2% women) returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Differences by gender in the prescription of Class 1, Level of Evidence A guideline-directed medical therapy among patients who developed incident CAD and HF at 30 days, 90 days, and 12 months after diagnosis. For CAD, medications included statins and antiplatelet therapy. For HF, medications included beta-blockers and renin-angiotensin-aldosterone system inhibitors. Overall, women developed CAD and HF at a younger average age than men (mean 45.8 vs. 47.7 years, p<0.001; and 43.7 vs. 45.4 years, p<0.02, respectively). In the 12 months following a diagnosis of incident CAD, the odds of a woman receiving a prescription for at least one CAD drug was 0.85 (95% confidence interval [CI], 0.68–1.08) compared to men. In the 12 months following a diagnosis of incident HF, the odds of a woman receiving at least one HF medication was 0.54 (95% CI, 0.37–0.79) compared to men. Despite guideline recommendations, young women Veterans have approximately half the odds of being prescribed guideline-directed medical therapy within 1-year after a diagnosis of HF. These results highlight the need to develop targeted strategies to minimize gender disparities in CVD care to prevent adverse outcomes in this young and growing population.
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影响因子：
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