Sex disparities in cardiovascular risk factor control following acute coronary syndrome

Abstract

Aim: To evaluate sex-based differences in cardiovascular risk factor (CVRF) control among post-acute coronary syndrome (ACS) patients in a 12-month Structured Coronary Disease Cardiology Consultation (SCCC) program. Methods: Retrospective observational study on consecutive patients enrolled in SCCC. Primary endpoints included achieving recommended CVRF [low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and glycated hemoglobin (HbA1c) in type 2 diabetes mellitus (DM)] targets. Mixed-effect models and logistic regression were used, controlling for covariates. Results: 339 patients were included [253 (74,6%) male; 86 (25,4%) female]. LDL-C decreased in both sexes (males: 101.0 to 52.0 mg/dL, p<0.001; females: 104.0 to 55.5 mg/dL, p<0.001), with no significant sex effect (p=0.6). LDL-C target was reached by 40% males and 33.3% females. HbA1c decreased in DM patients (males: 7.2% to 6.5%, p<0.001; females: 7.0% to 6.6%, p=0.39) with a significant sex effect favoring males (p=0.026). Glycemic control was achieved by 46.8% males and 42.3% females. SBP decreased in both groups (males: 134.0 to 127.0 mmHg, p<0.001; females: 141.0 to 134.0 mmHg, p<0.001), despite a nonsignificant sex effect (p=0.2). SBP target was met by 73.6% males and 59.5% females. Sex did not impact the achievement of LDL, HbA1c and SBP targets. Conclusions: The SCCC program improved CVRF control. While sex had no impact on LDL-C or SBP, diabetic females had poorer glycemic improvement, underscoring the importance of sex-specific secondary prevention strategies.