Differences in CV medication prescription prevalence between men and women in primary care

Sex Differences in Cardiovascular Medication Prescription in Primary Care: A Systematic Review and Meta-Analysis

Literature - Zhao M, Woodward M, Vaartjes I et al., - J Am Heart Assoc. 2020. doi: 10.1161/JAHA.119.014742.

Introduction and methods

Efforts have been made to characterize CVD in women over the last decades. This has resulted in insights in sex differenced in the presentation, diagnosis, and medical treatment of CVD [1,2]. Studies on sex differences in CVD managements have primarily been performed in secondary care settings [3-6]. It has remained unclear whether differences between men and women in CVD management exist in primary care. In this study, a systematic review and meta-analysis was performed to determine the prevalence of CV medication prescription in men and women in primary care.

This study included observational studies that reported sex-specific prevalence of prescriptions of CV medications in patients at high risk or with established CVD (coronary heart disease, stroke, heart failure, and atrial fibrillation). The prevalence of the following CV medications was analyzed: aspirin, statins, any antihypertensive medications (including beta blockers, calcium channel blockers [CCBs], angiotensin-converting enzyme inhibitors [ACE inhibitors]), and diuretics.

Random effects meta-analysis was used to analyze pooled women-to- men prevalence ratios for each CV medication prescription. The primary outcome was the women-to-men prescription prevalence ratio with 95%CI for each CV medication. Secondary outcomes included sex-specific prescription rates of each CV medication.

Main results

  • A total of 43 studies (n=2,264,600) were included. 28% Of participants were women and the mean age ranged from 51 to 76 years. 18 Studies included information on aspirin, 30 on statins, 14 on any antihypertensive medication, 21 on beta blockers, 13 on CCBs, 21 on ACE inhibitors and 14 on diuretics.
  • The pooled prevalence of CV medication prescription in women was 41% for aspirin, 60% for statins, and 68% for overall antihypertensive medications. The rates for men were 56%, 63%, and 69%, respectively.
  • The pooled women-to-men prevalence ratios were 0.81 (95%CI 0.72-0.92) for aspirin, 0.90 (95%CI 0.85-0.95) for statins, and 1.01 (95%CI 0.95-1.08) for any antihypertensive medication.
  • When looking at individual antihypertensive medication prescription, women were less likely to be prescribed with ACE inhibitors than men (women-to-men prevalence ratio: 0.85, 95%CI 0.81-0.89). On the other hand, the prevalence of diuretics prescription was higher in women than men (women-to-men prevalence ratio: 1.27, 95%CI 1.17-1.37). No significant se differences were found in the prescription of beta blockers and CCBs.


This study found sex-differences in the prescription prevalence in primary care among patients at high risk or with established CVD. Prescription prevalence was lower for aspirin, statins and ACE inhibitors, but higher for diuretics in women, compared to men. Further studies are needed to identify the underlying causes of the sex-differences in prescription prevalence in primary care.


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2. Woodward M. Cardiovascular disease and the female disadvantage. Int J Environ Res Public Health. 2019;16:1165.

3. Zhao M, Vaartjes I, Graham I, Grobbee D, Spiering W, Klipstein-Grobusch K, Woodward M, Peters SAE. Sex differences in risk factor management of coronary heart disease across three regions. Heart. 2017;103:1587–1594.

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6. De Smedt D, De Bacquer D, De Sutter J, Dallongeville J, Gevaert S, De Backer G, Bruthans J, Kotseva K, Reiner Z, Tokgozoglu L, et al. The gender gap in risk factor control : effects of age and education on the control of cardiovascular risk factors in male and female coronary patients. The EUROASPIRE IV study by the European Society of Cardiology. Int J Cardiol. 2016;209:284–290.

Find this article online at J Am Heart Assoc.

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