Sex-related differences regarding results of lipid-lowering therapies, implemented through telematic consultation, after an acute coronary syndrome
Authors: Perez Asensio A , Jimenez Mendez C , Mialdea Salmeron D , Puche J E , Silva E , Delgado Nava W , Bartolome Mateos D , Alarcon De La Lastra Cubiles I , Gheorghe L , Lubian Esplugues J I , Gonzalez Guerrero C , Gonzalez Armayones M , Martin Alfaro L E , Urgiles Ortiz M , Vazquez Garcia R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Women are less likely than men to receive guideline-recommended therapies. There is thus little real world information on possible sex-related differences regarding results of lipid lowering therapies when guidelines are correctly applied. Understanding possible sex-related differences in lipid profile’s response to treatment after an acute coronary syndrome (ACS) might provide important information in order to improve clinical outcomes.
Objetives: To assess, in a real world cohort, if there are any sex-related differences regarding results of lipid-lowering therapies, implemented through telematic consultation, after an ACS.

Methods
A prospective cohort study that consecutively recruited all patients admitted to our centre for an ACS from January 1, 2020 to December 31, 2020, was performed. All patients were discharged with high-intensity statins and other currently recommended cardiovascular drugs. Lipid profile was evaluated 1-month after discharge. Patients were then contacted by phone and their lipid-lowering therapy adjusted according to blood test’s results. This procedure was repeated every month until LDL-c target (≤ 55 mg/dl) was achieved in accordance with current European clinical practice guidelines.
Descriptive statistics of patient characteristics at baseline and end of follow up were calculated for the overall population and then compared between men and women. We determined statistical differences between women and men using chi-squared and Student's t.

Results
346 patients were included, of which 32% were women. Patient characteristics are summarized in Table 1. Women were significantly older than men (72 ± 12 vs 65 ± 12 years, p&lt;0.001) and had more past history of hypertension and dyslipidemia. There were no differences in clinical presentation at admission (predominantly non-ST elevation myocardial infarction). Mean follow-up was 17.3 months. Even though there were no statistically significant differences in treatment prescription at discharge or after follow up, women reached the goal of LDL ≤55 mg/dl in a lower proportion to men (75.5% vs 84.3%, p 0.031) and required more time (3.69 ±2.24 vs 2.92 ± 1.95 months, p &lt; 0.001). During follow up, total mortality was similar between groups, however women presented a higher cardiovascular mortality (4.5% vs 0.4%, p 0.014).

Conclusion
Our findings suggest that, applying the same guideline-recommended therapies in both women and men, there might be sex-related differences regarding lipid-lowering therapies’.

Results
Women reach the goal of LDL ≤55 mg/dl in a lower proportion to men and require more time. These results suggest that women might therefore need more aggressive treatment at discharge. Clinical significance of these findings is yet to be determined as our cohort is limited.