(191) Sex differences in dispensed cardiovascular medication in primary care

Background: Drug therapy plays a pivotal role in primary and secondary prevention of cardiovascular diseases (CVDs). Previous studies have described sex differences in the use of single drugs, with different patterns for lipid-level lowering and antihypertensive therapies. However, individuals typically use multiple drugs, and it is unclear whether sex differences also exist in cardiovascular combination therapy.

Objectives: To assess dispensed cardiovascular drugs, in isolation and in combination, between men and women in primary care.

Methods: Data were used from individuals ≥40 years old in the PHARMO Data Network between 2010 and 2020, including linked data from community pharmacies and primary care across the Netherlands. Included individuals were either at high risk for CVD or previously diagnosed with CVD. Dispensed cardiovascular drugs were classified into ten medication classes based on their active substances. Concurrent medication was defined as active substances dispensed in the same half year. Patterns for stratified groups were assessed per half year by number of concurrent dispensed active substances, prevalences of medication combinations, and prevalence ratios by sex.

Results: In total, 61,593 people (40% women) at high risk for CVD and 87,242 people with a history of CVD (45% women) were included. Single dispensings were more common for women than men (prevalence ratio women/men (PRw/m), median = 1.17 [interquartile range: 1.15-1.18]), while ≥5 dispensings were more common for men (PRw/m, median = 0.91 [IQR: 0.86-0.93]). Forty-eight out of 660 active substance combinations had a mean prevalence ≥1%. Prevalence ratios between sexes showed that combinations with diuretics were more common in women (e.g., a beta-blocker and a diuretic, PRw/m, median = 2.43 [IQR: 2.14-2.72]). In contrast, combinations with statins or antithrombotics were more common in men (e.g., an ACE inhibitor, an antithrombotic, a beta-blockers, and a statin, PRw/m, median = 0.44 [IQR: 0.44-0.45]).

Conclusions: This study highlights sex differences in the use of cardiovascular medication; women are more often prescribed single active substances and men are more often prescribed ≥5 active substances. More women take combinations with diuretics, while for men, combinations with statins or antithrombotics are more common.