Gender differences in utilization of effective cardiovascular secondary prevention: a Cleveland clinic prevention database study.
BACKGROUND
Previous studies have suggested that women with cardiovascular disease may receive less aggressive care than men. Using a large cardiology database from a tertiary referral center, we sought to determine if treatment differences still persist in the current era.


METHODS
We analyzed data on 2462 patients who were referred for secondary prevention to the Preventive Cardiology Clinic at The Cleveland Clinic Foundation between 1997 and 2004. The primary objective was to evaluate use of effective secondary preventive therapies, by gender, as outlined in the ACC/AHA guidelines, such as antiplatelet therapy, beta-blockers, statins, and angiotensin-converting enzyme (ACE) inhibitors. Multivariate logistic regression analysis was performed to assess the independent effect of gender on all cause mortality.


RESULTS
Women were older (62.2 +/- 11.1 vs. 59.4 +/- 11.0, p < 0.001) and more likely to be hypertensive (68.1% vs. 56.1%, p < 0.001) than men. Overall, women were more likely than men to have higher baseline C-reactive protein (CRP) (6.14 +/- 13.4 vs. 4.9 +/- 10.7, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (135 +/- 66 vs. 116 +/- 46, p < 0.001), high-density lipoprotein cholesterol (HDL-C) (52 +/- 17 vs. 41 +/- 11, p < 0.001), and total cholesterol (238 +/- 98 vs. 202 +/- 65, p < 0.001). Women were less likely to be on antiplatelet therapy (76.6 % vs. 85.0%, p < 0.001) and statins or any lipid-lowering therapy (62.6% vs. 67.1%, p = 0.04) compared with men on presentation.


CONCLUSIONS
Even in the current era, women with established cardiovascular disease continue to receive less aggressive care than men. They are less likely to be on aspirin and statin therapy. More aggressive efforts should be made to treat both men and women with standard secondary preventive efforts.
Cho
Leslie
L
Women's Cardiovascular Center, Preventive Cardiology and Rehabilitation, Cleveland Clinic, Cleveland, Ohio 44195, USA. chol@ccf.org
Hoogwerf
Byron
B
Huang
Julie
J
Brennan
Danielle M
DM
Hazen
Stanley L
SL
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000592:standards; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D016387:Women's Health
D000960:Hypolipidemic Agents