Prognostic impact of high-intensity lipid-lowering therapy under-prescription after acute myocardial infarction in women
Authors: Weizman Orianne , Hauguel-Moreau Marie , Tea Victoria , Albert Franck , Barragan Paul , Georges Jean-Louis , Delarche Nicolas , Kerneis Mathieu , Bataille Vincent , Drouet Elodie , Puymirat Etienne , Ferrières Jean , Schiele François , Simon Tabassome , Danchin Nicolas ,   for the FAST-MI Investigators, Albert F , Aliot E , Allal J , Allam S , Allard-Latour G , Amat G , Amor M , Andriambololona M , Assayag P , Asseman P , Banos J-L , Baradat G , Bardet J , Bareiss P , Barnay C , Bassand J-P , Baudouy M , Baudouy P , Baulleret G , Bazin P , Beaufils P , Beauverger Y-M , Becquart J , Belle L , Berland J , Bernard P , Beruben E , Bessede G , Bickert P , Bineau-Jorisse A , Blanc J-J , Blanchard D , Bonneau A , Bonnet P , Bourdon J-L , Boureux C , Boutaud P , Bouvier J-M , Brunel H-P , Cazenave P , Cador R , Cardinaud P , Carette B , Carlioz  , Casteigt F , Cattan S , Cazaux P , Chaussard C , Charbonnier B , Chounet J , Claudon O , Coatantiec G , Coeurderoy A , Convert G , Coste P , Coulon P , Coupillaud J , Courdier G , Cressens J-P , Cribier A , D'Amato J , Dambrine P , Danchin N , De Boisgelin X , Delarche N , Dentan G , Destrac S , Deturck R , Dewilde J , Dibie A , Djiane P , Doazan J-P , Druelles P , Dubourg O , Duclos F , Dujardin J-J , Dulhoste M-N , Dupouy P , Elaerts J , Elgohary  , Elhadad S , Escande-Orthlieb M , Escojido H , Estampes B , Eymerit P , Fichter P , Flammang D , Font M , Fourdilis M , Fournier P , Francoual M , Fromage P , Galley D , Garnier H , Gauffre O , Genet L , Geslin P , Ghanem M , Godard S , Godenir J-P , Goburdhun C , Grison D , Grollier G , Gueniche C , Guenot O , Gueret P , Guerin Y , Guillot J-P , Gully C , Halary J-J , Hannebicque G , Mycinski C , Hanssen M , Heiligenstein D , Heraudeau A , Hochart P , Hueber A , Huguet R-G , Huret B , Jambert H , Jebai  , Jullien J , Karsenty B , Khalife K , Kahn J-C , Kirkorian G , Lagorce P , Lahneche  , Lancelin B , Lang M , Lanteme P , Lapeyre G , Lardoux H , Lassabe A , Laurent Y , Leclercq F , Ledain L , Lefevre T , Lemoine C , Levai L , Le Marrec  , Mabo P , Machecourt J , Magnin D , Mailler J-P , Marier J-J , Marco F , Marcon J-L , Martelet M , Meimoun P , Messner-Pellenc P , Mettauer B , Metzger J-P , Meurice T , Monassier J-P , Monnier A , Monsegu J , Montely J-M , Morice J , Mossard J-M , Normand  , Olive  , Oltean I , Paemelaere J-M , Paganelli F , Pagny J-Y , Pailloncy M , Palcoux M-C , Parola J-L , Peltier B , Pernes J-M , Pichene M , Pierre-Justin E , Pochmalicki G , Poitrineau O , Ponsonnaille J , Poulard J-E , Pruvost P , Puel J , Quandalle P , Quiret J-C , Rebuffat G , Rihani R , Ritz B , Rioux P , Rouffaud J , Rondepierre D , Ronteix J-F , Saadouni E-H , Sader R , Sans P , Sarfati L , Sivery B , Slama M , Soto F-X , Tabone X , Thieuleux F , Thisse J-Y , Thourot G , Tissot M , Tissot T-A , Toussaint C , Traisnel G , Tran  , Tremeau G , Vahanian A , Michel P-L , Valeix B , Vahdat B , Vergnouix H , Viallet M , Vilarem D , Virot P , Vittrant J , Weber S , Wolf J-E , Wyart P , Zabel A , Zupan Sihcus M , Cottin Y , Coste P , Lognogne T , Roul G , De Breyne B , Moulin F , Khalife K , Vanzetto G , Carrie D , Jouve B , Leurent G , Schiele F , Hammer L , Faure E , Probst V , Boschat J , Motreff P , Ritz B , Le RAY C , Andrieu S , Lucke V , Rouault G , Faure J P , Levy G , Leclercq F , Robin C , Valy Y , Asseman P , Danchin N , Schmutz L , Delarche N , Wiedemann J Y , Tabone X , Pacouret G , Schwob J , Lim P , Orion L , El Moujahid M , Druelles P , Belle L , Fajadet J , Perron J M , Henry P , Rosak P , Ducrocq G , Tron C , Duvilla N , Elhadad S , Demicheli T , Rouselle V , Cazaux S , Ballout J , Genet L , Herce B , Banos J L , Jarry G , Benamer H , Montely J M , Joly P , Paganelli F , Delaunay R , Tibi T , Dentan G , Boulard P , Champagnac D , Soto F X , Bonnet J L , Le Francois Y , Duclos F , Luycx-Bore A , Boureux C , Collet J P , Dupouy P , Ravan R , Amor M , Bonnet P , Marchand X , Bourkaib R , Ben AMER H , Maillier B , Pilliere R , Bernard P , Coisne D , Berthier R , Fayard M , Magdelaine B , Pichene M , Werquin S , Aelion H , Boccara A , Armengaud J , Meyer P , Ferrari E , Jarnier P , Karsenty B , Bodart J C , Jullien T , Barragan P , Koujan B , Dadez E , Huret B , Boueri Z , Graux P , Lantelme P , Le BRIS H , Nait Saidi L , Raoux F , Coco M , Monassier J P , Favereau X , Brasselet C , Traisnel G , Dupouy P , Nallet O , Cerisier A , Chevalier B , Furber A , Koegler A , Sedighian S , Petiteau P Y , Perrot S , Bessede G , Verdun A , Fourrier J L , Maillard L , Brunel P , Coupillaud J , Slama M , Sader R , Darchis J , Elkaim J P , Vahdat B , Kamal H , Zaehringer M , Philippe F , Cador R , Bettioui A , Poulard J E , Allard Latour G , Broucqsault D , Ettori J , Bernasconi F , Casteigt F , Hueber A , Mettauer B , Schiano P , Loiselet P , Roynard J L , Martelet M , Godenir J P , Dujardin J J , Saadouni H , Fromage P , Michel L , Ley N , Breut C , Faverau X , Fonseca E , Allam S , Beruben E , Admant P , Cohen A , Laurent I , Haas J , Eymerit P , Lescure M , Gabriel A , Belhassane A , Litalien J , Souk-Aloun J , Fourrier J L , Rioux P , Brunelle F , Hamani D , Sarfati L , Thieuleux F , Berenfeld A , Airaud P , Decoulx E , Heroguelle V , Claudel J P , Ribier A , Cellarier G , Magnin D , Megbemado R , Mischke U , Baborier D , Thisse J Y , Jellouli B , Demarcq J M , Hugon J P , Funck F , Mteirek M , Bourdon J L , Dutoit L , Bineau-Jorisse A , Joly P , Ray J P , Tarragano F , Jebai H , Baradat G , Tissot M , Bureau G , Decourcelle V , Halary J J , Bienvenu M P , D'Hautefeuille B , Gosselin G , Coz E , Claudon O , Galley D , Benderbous R , Destrac S , Jouve B , Peycher P , Rumeau P , Leborgne L , Furber A , Lucke Simandoux V , Bernasconi F , Duclos F , Saint-Pierre F , Grebet J , Haddad V , Jessen P , Walylo F , Dutoit L , Soto F , Andrieu S , Sainsous J , Faure A , Labeque J , Dumessi K , Lefrancois Y , Baciulescu L , Petiteau P , Schiele F , Mycinski C , Kadri A , Marque N , Gommeaux A , Darremont O , Laine M , Mansencal N , Nugue O , Mayaud N , Tabone X , Castellant P , Faure J , De Breyne B , Beygui F , Richard P , Tremeau G , Tibi T , Grossetete R , Salva P , Beruben E , Fayard M , Descotes-Genon V , Angoulvant D , Houeze F , Poitrineau O , Pon-Gabrielsen P , Slama M , Motreff P , Greciano S , Plastaras P , Luycx Bore A , Berthier R , Baixas C , Aouate P , Lim P , Roynard J , Farhat A , Cottin Y , Napporn G , Jabourek O , Werquin S , Baala B , Admant P , Breton C , Taamallah S , Dentan G , Lamit X , Hidoud A , Poulos N , Marchand S , De Poli F , Diallo A , Orion L , Valy Y , Vanzetto G , Beaudet B , Deslandes Y , Charbonnel C , Demichelli T , Lesault P , Assayag P , Rosak P , Gostine S , De Tauriac O , El Moujahid M , Chevalevreau P , Lemesle G , Meurice T , Bontemps T , Aboyans V , Landel J , Durup F , Cazaux P , Perret T , Harbaoui B , Bert-Marcaz P , Bouvier J , Paganelli F , Bonnet J L , Khanoyan P , Bouriche F , Lefevre T , Jellouli B , Gasmi M , Khalife K , Moulin F , Rougier P , Somody E , De Labriole A , Milon C , Nallet O , Bonnet P , Roche R , Levy G , Leclercq F , Boccara A , Cornec P , Bresson D , Schultz R , Pichene M , Digne F , Probst V , Dib J C , Ballout J , Ferrari E , Maupas E , Cayla G , Lucas G , Genee O , Dibon O , Saal J , Henry P , Cohen A , Silvain J , Cador R , Varenne O , Danchin N , Ducrocq G , Delarche N , Jarnier P , Sultan P , Karsenty B , Coste P , Marchand X , Coisne D , Funck F , Belle L , Joseph T , Chayeb S , Brasselet C , Herve B , Druelles P , Mabo P , Flork L , Kaaki A , Souk Aloun J , Legros G , Du Villa N , Tron C , Taldir G , Guyon P , Isaaz K , Haddad Z , Jebai H , Mihoubi A , Brignon M , Temam R , Saouli D , Godreuil C , Chmait A , Remy J , Tchtchoua D , Henon P , Deltreuil M , Grentzinger A , Richard C , Pacaud D , Ettori J , Ledon S , Zaehringer M , Ohlmann P , Scemama A , Beard T , Dupont J , Poyet R , Farah B , Elbaz M , Delcoux E , Muligo A , Maillier B , Berenfeld A , Champin S , Moussa K , Popovic B , Le Ray C , Onceanu S , Marcaggi X , Maes D , Salengro E 
Published: August 2024

Aims

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.

Methods and 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 &lt; 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 &lt; 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 &lt; 0.001 and adjusted HR: 0.81(95% CI: 0.74–0.89); P &lt; 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].

Conclusion

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.