Sex differences in risk factor control and medication adherence post-ACS
insights from the TEXTMEDS randomised clinical trial
Good risk-factor control and medication adherence after an acute coronary syndrome (ACS) help determine long-term prognosis, and sex plays a role. In this secondary analysis of the randomised TEXTMEDS trial (1,379 patients post-ACS, 79% male), sex differences in secondary-prevention targets were examined. Women were less likely to reach the LDL-cholesterol target (<1.8 mmol/L; aOR 0.61) and to exercise regularly (aOR 0.61), but more likely to achieve a healthy BMI (aOR 1.47). Women were also less adherent to medication (aOR 0.68), though this association weakened and lost significance after adjustment for socioeconomic factors. The findings argue for sex-sensitive strategies for risk-factor control and adherence to improve cardiovascular outcomes.
Summary
Introduction
Poor adherence to risk factor control and life-saving medications is a key factor affecting long-term patient prognosis. Evidence indicates that sex plays a significant role in the uptake of both pharmacological and non-pharmacological interventions, ultimately influencing long-term outcomes. This study aimed to quantify sex differences in risk factor management and medication adherence following acute coronary syndrome (ACS).
Methods
This is a secondary analysis of the TEXTMEDS randomised clinical trial - a single-blind, multicentre randomised controlled trial of patients post-ACS. We compared sex differences in achieving clinical and lifestyle targets for secondary prevention, namely blood pressure control (<140/90 mm Hg), low-density lipoprotein cholesterol (LDL-C) (<1.8 mmol/L), healthy body mass index (BMI) (<25 kg/m²), regular physical activity (Global Physical Activity Questionnaire score ≥600), smoking status and adherence to cardioprotective medications (aspirin, beta blockers, ACE/angiotensin receptor blockers, statins, antiplatelets), using adjusted logistic regression models. Medication adherence was defined as taking ≥80% of prescribed doses in the month prior to follow-up, across all five drug classes, unless contraindicated.
Results
Of 1379 patients (mean age 58.5±10.7 years; 1095 (79.4%) male), females were less likely than men to achieve LDL-C targets (adjusted OR (aOR): 0.61, 95% CI 0.45 to 0.82) and engage in regular physical activity (aOR: 0.61, CI 0.47 to 0.80), but more likely to achieve a healthy BMI (aOR: 1.47, CI 1.04 to 2.06). Female patients are less likely to adhere to their medication compared with male counterparts (aOR: 0.68, CI 0.50 to 0.92). However, this association weakened and lost statistical significance after further adjustment for socio-economic factors (aOR: 0.71, CI 0.50 to 1.03). There were no significant interactions between sociodemographic or clinical factors and sex in relation to overall medication adherence (P-interactions >0.05).
Conclusion
This study reveals that female patients are less likely to achieve LDL-C targets and engage in physical activity but more likely to maintain a healthy BMI. Although females showed lower medication adherence, this association weakened after adjusting for socio-economic factors. These findings highlight the importance of sex-sensitive strategies focusing on risk factor control and medication adherence for improving cardiovascular health outcomes.
Trial registration number
ACTRN12613000793718.
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