Sex differences in monitoring and achievement of blood pressure and LDL-cholesterol targets in chronic coronary syndrome

Abstract

Background: The cornerstones of secondary prevention in chronic coronary syndrome (CCS) are blood pressure lowering and lipid-lowering therapy (LLT). The purpose of this study was to examine the control of systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) in patients with CCS followed in primary care.

Methods: This was a retrospective population-based cohort study of patients diagnosed with CCS at cardiology clinics in Uppsala Region, Sweden, between 2012 and 2020. Data from electronic health records were analyzed for SBP and LDL-C monitoring and secondary prevention target achievement during 3 years of follow-up, stratified by sex, age, and diabetes status. Sex differences in time to LLT initiation during the first year after CCS diagnosis were evaluated using Cox proportional hazards models.

Results: In total, 1,452 patients (415 women and 1,037 men) were followed for a median of 3.2 years (interquartile range [IQR]: 1.4–5.8). Most patients had at least one SBP measurement during follow-up, and approximately half met SBP targets (50.9% of women and 56.1% of men at year 1). LDL-C monitoring was less common: at year 1, 40.8% of women and 28.7% of men lacked a measurement, and targets were achieved in 12.1% of women and 24.7% of men. By year 3, target achievement had declined further to 11.2 and 15.0%, respectively. Women were less likely than men to initiate LLT within the first year (adjusted hazard ratio 0.70, 95% confidence interval: 0.61–0.80, P < 0.001). LLT use also declined over time, with 54.1% of women versus 73.9% of men on treatment at year 3 (P < 0.001).

Conclusion: Large gaps in secondary prevention of patients with CCS were observed, with under-monitoring of LDL-C and declining use of LLT, particularly among women. Although SBP was routinely assessed, only half of patients achieved recommended levels. These findings highlight the need for systematic strategies in primary care to improve management in CCS.