Key result
Post-ACS females are ~39% less likely than males to achieve LDL-C and physical activity targets.
Why the study?
Sex plays a significant role in the uptake of pharmacological and non-pharmacological interventions post-ACS, but sex differences in risk factor management and medication adherence needed quantification.
Do female patients post-ACS have different rates of risk factor control and medication adherence compared to male patients?
Do female patients post-ACS have different rates of risk factor control and medication adherence compared to male patients?
Following ACS, female patients are less likely to achieve LDL-C and physical activity targets compared to males, highlighting the need for sex-sensitive secondary prevention strategies.
Supports sex-sensitive secondary prevention post-ACS; extends low-certainty observational evidence of persistent sex disparities.
Introduction Poor adherence to risk factor control and life-saving medications is a key factor affecting long-term patient prognosis. Evidence indicates that sex plays a significant role in the uptake of both pharmacological and non-pharmacological interventions, ultimately influencing long-term outcomes. This study aimed to quantify sex differences in risk factor management and medication adherence following acute coronary syndrome (ACS). Methods This is a secondary analysis of the TEXTMEDS randomised clinical trial - a single-blind, multicentre randomised controlled trial of patients post-ACS. We compared sex differences in achieving clinical and lifestyle targets for secondary prevention, namely blood pressure control (<140/90 mm Hg), low-density lipoprotein cholesterol (LDL-C) (<1.8 mmol/L), healthy body mass index (BMI) (<25 kg/m²), regular physical activity (Global Physical Activity Questionnaire score ≥600), smoking status and adherence to cardioprotective medications (aspirin, beta blockers, ACE/angiotensin receptor blockers, statins, antiplatelets), using adjusted logistic regression models. Medication adherence was defined as taking ≥80% of prescribed doses in the month prior to follow-up, across all five drug classes, unless contraindicated. Results Of 1379 patients (mean age 58.5±10.7 years; 1095 (79.4%) male), females were less likely than men to achieve LDL-C targets (adjusted OR (aOR): 0.61, 95% CI 0.45 to 0.82) and engage in regular physical activity (aOR: 0.61, CI 0.47 to 0.80), but more likely to achieve a healthy BMI (aOR: 1.47, CI 1.04 to 2.06). Female patients are less likely to adhere to their medication compared with male counterparts (aOR: 0.68, CI 0.50 to 0.92). However, this association weakened and lost statistical significance after further adjustment for socio-economic factors (aOR: 0.71, CI 0.50 to 1.03). There were no significant interactions between sociodemographic or clinical factors and sex in relation to overall medication adherence (P-interactions >0.05). Conclusion This study reveals that female patients are less likely to achieve LDL-C targets and engage in physical activity but more likely to maintain a healthy BMI. Although females showed lower medication adherence, this association weakened after adjusting for socio-economic factors. These findings highlight the importance of sex-sensitive strategies focusing on risk factor control and medication adherence for improving cardiovascular health outcomes. Trial registration number ACTRN12613000793718.
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Mishra et al. (2026) studied this question. Post-ACS females were less likely than males to achieve LDL-C targets (aOR 0.61) and regular physical activity (aOR 0.61), but more likely to maintain a healthy BMI (aOR 1.47).
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