目的:女性在急性心肌梗死(AMI)后接受降脂治疗(LLT)的可能性较小。我们分析了这种处方不足是否持续存在并对长期结果产生影响。
结果:FAST-MI计划包括全国范围的登记,包括2005年、2010年和2015年发病后1个月内所有AMI≤48h的患者,并进行长期随访。此分析集中于高强度LLT(阿托伐他汀≥40mg或等效,或他汀类药物和依泽替米贝的任何组合)。12659例患者中女性占28%(N=3547)。出院时,高强度LLT在女性中的处方明显较少[54vs.68%的男性P<0.001,调整后比值比(OR)0.78(95%置信区间(CI)0.71-0.87)],随着时间的推移没有改善的趋势:2005年,25vs.35%(P=0.14);2010年,6679%(P<0.001);2015年,67vs.79.5%(P=0.001)。相比之下,女性与出院时缺乏其他推荐治疗无关:β受体阻滞剂[校正OR0.98(95%CI0.88-1.10),P=0.78],或肾素-血管紧张素阻滞剂[校正OR0.94(95%CI0.85-1.03),P=0.18]。出院时高强度LLT与女性的5年生存率和无梗死和无卒中生存率显著相关[校正风险比(HR)0.74(95%CI0.64-0.86),P<0.001,调整后的HR:0.81(95%CI:0.74-0.89);P<0.001,分别]。使用倾向评分匹配分析[高强度LLT女性5年生存率的HR:0.82(95%CI0.70-0.98),P=0.03]。
结论:女性在AMI后高强度LLT处方方面存在偏见,在2005年至2015年期间并未减弱,对生存率和心血管事件风险均有潜在影响.
急性心肌梗塞(AMI)后女性的降脂治疗(LLT)处方不足。这种差异是否会随着时间的推移而持续存在并影响长期结果尚不清楚。女性在AMI后出院时仍然缺乏高强度LLT的处方,即使在最近几年的研究中,未接受大剂量LLT的女性5年生存率显著降低倾向评分匹配分析显示,生存率和心血管事件的结果相似.
OBJECTIVE: Women are less likely to receive lipid-lowering therapy (LLT) after acute myocardial infarction (AMI). We analysed whether this under-prescription currently persists and has an impact on long-term outcomes.
RESULTS: The FAST-MI programme consists of nationwide registries including all patients admitted for AMI ≤ 48 h from onset over a 1 month period in 2005, 2010, and 2015, with long-term follow-up. This analysis focused on high-intensity LLT (atorvastatin ≥ 40 mg or equivalent, or any combination of statin and ezetimibe) in women and men. Women accounted for 28% (N = 3547) of the 12 659 patients. At discharge, high-intensity LLT was significantly less prescribed in women [54 vs. 68% in men, P < 0.001, adjusted odds ratio (OR) 0.78(95% confidence interval (CI) 0.71-0.87)], a trend that did not improve over time: 2005, 25 vs. 35% (P = 0.14); 2010, 66 vs. 79% (P < 0.001); 2015, 67 vs. 79.5% (P = 0.001). In contrast, female sex was not associated with a lack of other recommended treatments at discharge: beta-blockers [adjusted OR 0.98(95% CI 0.88-1.10), P = 0.78], or renin-angiotensin blockers [adjusted OR 0.94(95% CI 0.85-1.03), P = 0.18]. High-intensity LLT at discharge was significantly associated with improved 5 year survival and infarct- and stroke-free survival in women [adjusted hazard ratios (HR) 0.74(95% CI 0.64-0.86), P < 0.001 and adjusted HR: 0.81(95% CI: 0.74-0.89); P < 0.001, respectively]. Similar results were found using a propensity score-matched analysis [HR for 5 year survival in women with high-intensity LLT: 0.82(95% CI 0.70-0.98), P = 0.03].
CONCLUSIONS: Women suffer from a bias regarding the prescription of high-intensity LLT after AMI, which did not attenuate between 2005 and 2015, with potential consequences on both survival and risk of cardiovascular events.
Lipid-lowering therapy (LLT) is under-prescribed in women after acute myocardial infarction (AMI). Whether this difference persists over time and influences long-term outcomes is unclear. Women still suffer from insufficient prescription of high-intensity LLT at discharge after an AMI, even in the most recent years of the study, with a 5 year survival significantly reduced in women who did not receive high-dose LLT Propensity score matched analysis showed similar results on survival and cardiovascular events.