Women With Premature ASCVD Report Overall Poor Physical, Mental Health

Salim S. Virani, MD, PhD

In order to highlight the importance of determining the extent to which sex-based differences exist for adult patients with premature atherosclerotic cardiovascular disease (ASCVD), a recent study investigated the association of sex with physical and mental health domains, as well as healthcare access-related factors.

It found that in fact, women with premature ASCVD were more likely to report worse overall physical and mental health, inability to see a physician as a result of cost, and cost-related medical nonadherence, compared to men.

The Study

A team led by Salim S. Virani, MD, PhD, Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, utilized the Behavioral Risk Factor Surveillance System (BRFSS) survey from 2016 - 2019 to identify adults aged 18 - 55 years.

Self-reported data included the presence of cardiovascular comorbidities, including hypertension, dyslipidemia, diabetes, and chronic kidney disease.

Additionally, Virani and colleagues obtained ASCVD status through the question “Have you ever had coronary heart disease or myocardial infarction or stroke?”, with those answered positively considered to have self-reported premature ASCVD.

Other self-reported information included physical and mental health domains, sex, race and ethnicity, and medication adherence. Investigators performed multivariable logistic regression analyses to study the association of sex with physical and mental health domains, and healthcare access in this patient population.

Findings

The study population consisted of 748,090 patients between the ages of 18 - 55 years, with 28,522 (3.3%) self-reporting a history of ASCVD. From this population, 14,358 (47.0%) were women, who were more often Black, had lower income level, and less likely to report hypertension, hyperlipidemia, and diabetes.

Further, data show that compared with men, women with premature ASCVD were more likely to report being clinically depressed (odds ratio, OR, 1.73; 95% CI, 1.41 - 2.14, P <.001), have cost-related medication nonadherence (OR, 1.42; 95% CI, 1.11 - 1.82, P = .005), and have not seen a physician due to cost related issues (OR, 4.52; 95% CI, 2.24 - 9.12, P <.001).

Additionally, women were more likely to report overall poor physical health (OR, 1.39; 95% CI, 1.09 - 1.78, P = .008), despite being more likely to have health care coverage (85.3% versus 80.8%, P = .04) and a primary care physician (84.2% versus 75.7%; P <.001) compared to men.

Takeaways

Virani and team noted that the findings suggest that although women are more likely to seek routine care, they may face barriers to access, including cost-related issues, dissatisfaction in physician communication, and complications in their mental well-being.

“We believe that, apart from therapeutic inertia on the part of clinicians treating patients with premature ASCVD, social determinants also differentially impact women with premature ASCVD more often than men, further exaggerating these disparities in both receiving evidence-based therapies and adherence to those therapies,” investigators wrote.

The study, “Evaluation of Factors Underlying Sex-Based Disparities in Cardiovascular Care in Adults With Self-reported Premature Atherosclerotic Cardiovascular Disease,” was published in JAMA Cardiology.