Sex Differences In Pharmacologic Optimal Medical Therapy For Ischemic Heart Disease, 2010-2020: An Observational Study

BackgroundDespite guideline recommendations for optimal medical therapy (OMT) in the secondary prevention of ischemic heart disease (IHD)--including antiplatelets, statins, renin-angiotensin-aldosterone system inhibitors (RAASi), and {beta}-blockers--substantial sex disparities in OMT utilization persist. The extent to which national efforts have mitigated these disparities in contemporary cohorts remains unclear. MethodsWe analyzed data from the 2011-2020 National Health and Nutrition Examination Survey (NHANES) cycles, identifying adults with self-reported IHD (defined as a history of myocardial infarction or coronary heart disease). OMT use in the preceding 30 days was assessed based on participant report and verified through medication containers when available. We evaluated trends in individual drug classes and common combinations, stratified by sex. ResultsAmong 1,905 adults (mean age 65.4 years; 40.6% women), women had significantly lower rates of OMT use compared to men, including antiplatelets (68.0% vs 77.7%), statins (57.2% vs 73.9%), RAASi (45.6% vs 59.0%), and {beta}-blockers (51.2% vs 61.1%). Women were also less likely to use guideline-recommended combinations such as aspirin plus statins (47.4% vs 64.1%) and all four OMT classes (17.5% vs 32.5%). After adjustment for sociodemographic and clinical factors, women remained less likely to use antiplatelets (OR 0.71; 95% CI, 0.52- 0.94), statins (OR 0.62; 95% CI, 0.40-0.96), and RAASi (OR 0.56; 95% CI, 0.38-0.84), while {beta}-blocker use did not differ significantly. These sex-based disparities were consistent across all survey cycles from 2011 to 2020. ConclusionIn this nationally representative study, women with IHD were significantly less likely than men to receive guideline-directed OMT, with persistent disparities over the past decade. These findings underscore the need for targeted strategies to close the sex gap in cardiovascular prevention.