Mansoor Hend, Manion Daniel, Kucharska-Newton Anna, Delcher Chris, Lo-Ciganic Wei-Hsuan, Jicha Gregory A, Moga Daniela C
Department of Pharmacy Practice and Science (H.M., D.M., C.D., D.C.M.), University of Kentucky, Lexington.
Department of Epidemiology and Environmental Health (A.K.-N., D.C.M.), University of Kentucky, Lexington.
Stroke. 2025 Feb;56(2):318-325. doi: 10.1161/STROKEAHA.124.048058. Epub 2024 Oct 1.
Ischemic stroke is a leading cause of death and disability. Society guidelines recommend pharmacotherapies for secondary stroke prevention. However, the role of sex differences in prescription and adherence to guideline-directed medical therapies (GDMT) after ischemic stroke remains understudied. The aim of this study was to examine sex differences in prescription patterns and adherence to GDMT at 1 year after ischemic stroke in a cohort of commercially insured patients.
Using the Truven Health MarketScan database from 2016 to 2020, we identified patients admitted with ischemic stroke. GDMT was defined as any statin, antihypertensive agents, or oral anticoagulant prescription within 30 days after discharge. Medication adherence was estimated using the proportion of days covered at 1 year. The proportion of days covered <0.80 was used to define nonadherence. A multivariable model adjusting for covariates was performed to identify the factors associated with nonadherence at 1 year. This analysis was restricted to new users of GDMT.
Among 155 220 patients admitted with acute ischemic stroke during the study period, 15 919 met the inclusion criteria. The mean age was 55.7 years, and 8218 (51.7%) were women. Women were less likely to be prescribed statins (58.0% versus 71.8%) and antihypertensive agents (27.7% versus 41.8%). In this subset of patients with atrial flutter/fibrillation, women were also less likely to be prescribed oral anticoagulants (41.2% versus 45.0%). Women were more likely to be nonadherent (ie, proportion of days covered <0.80) to statins (47.3% versus 41.6%; <0.0001), antihypertensives (33.3% versus 32.2%; =0.005), and the combination of both (49.6% versus 45.0%; =0.003). On multivariable analysis, women were likely to be nonadherent to statins and antihypertensive agents at 1 year (odds ratio, 1.23 [95% CI, 1.08-1.41]).
In this real-world analysis of commercially insured patients with ischemic stroke, women were less likely initiated on GDMT within 30 days after discharge. Women were more likely to be nonadherent to statins and antihypertensive agents at 1 year. Future efforts and novel interventions are needed to understand the reasons and minimize these disparities.
缺血性中风是导致死亡和残疾的主要原因。社会指南推荐药物疗法用于二级中风预防。然而，缺血性中风后在处方和遵循指南指导的药物治疗（GDMT）方面性别差异的作用仍未得到充分研究。本研究的目的是在一组商业保险患者队列中，研究缺血性中风后1年时处方模式和遵循GDMT方面的性别差异。
利用2016年至2020年的Truven Health MarketScan数据库，我们确定了因缺血性中风入院的患者。GDMT被定义为出院后30天内开具的任何他汀类药物、抗高血压药物或口服抗凝剂处方。使用1年时的覆盖天数比例来估计药物依从性。覆盖天数比例<0.80被用来定义不依从。进行了调整协变量的多变量模型分析，以确定与1年时不依从相关的因素。该分析仅限于GDMT的新使用者。
在研究期间因急性缺血性中风入院的155220例患者中，15919例符合纳入标准。平均年龄为55.7岁，8218例（51.7%）为女性。女性接受他汀类药物处方的可能性较小（58.0%对71.8%），接受抗高血压药物处方的可能性也较小（27.7%对41.8%）。在这一房颤/房扑患者亚组中，女性接受口服抗凝剂处方的可能性也较小（41.2%对45.0%）。女性更有可能不依从他汀类药物（覆盖天数比例<0.80，47.3%对41.6%；<0.0001）、抗高血压药物（33.3%对32.2%；=0.005）以及两者联合使用（49.6%对45.0%；=0.003）。在多变量分析中，女性在1年时更有可能不依从他汀类药物和抗高血压药物（比值比，1.23[95%CI，1.08 - 1.41]）。
在这项对商业保险的缺血性中风患者的真实世界分析中，女性在出院后30天内开始接受GDMT的可能性较小。女性在1年时更有可能不依从他汀类药物和抗高血压药物。需要未来的努力和新的干预措施来了解原因并尽量减少这些差异。
