Sex Differences in Coronary Heart Disease

Q: What are the key findings of this study?

Surgical menopause was associated with higher 5-year prescription rates of statins (7.2% vs 6.0%; OR 1.22), antihypertensives (21.9% vs 17.1%), and diabetes drugs (10.1% vs 7.7%) vs natural menopause.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Menopause (surgical via bilateral oophorectomy vs. nonsurgical natural/premature menopause) (n=719272). Intervention: Surgical menopause (bilateral oophorectomy) vs. Nonsurgical (natural) menopause. Primary outcome: Statin prescription rate at 5 years (co-primary with antihypertensive and diabetes medication prescription rates) (OR 1.22, 95% CI 1.14-1.30, p=<0.0001).

Q: What does this research mean for the field?

Patients with surgical menopause receive preventive cardiovascular and diabetes medications, including statins and antihypertensives, at significantly higher rates over five years than age- and comorbidity-matched patients with nonsurgical menopause. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To characterize longitudinal prescribing patterns of preventive cardiovascular medications between women experiencing nonsurgical versus surgical menopause to detect potential care disparities.

Elizabeth L. Barrett-Connor

doi:10.1161/01.cir.95.1.252

January 7, 1997Circulation

Sex Differences in Coronary Heart Disease

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Key result

Surgical menopause linked to ~22% higher statin prescription rates vs natural menopause at 5 years.

OR 1.22
95% CI 1.14-1.30
P<0.0001
n=719,272

Why the study?

The study aimed to characterize longitudinal prescribing patterns of preventive cardiovascular medications among women with nonsurgical and surgical menopause to identify potential differences in care.

Does surgical menopause compared with nonsurgical menopause increase the rate of prescriptions for statins, antihypertensive medications, and diabetes medications in midlife women aged 40 to 60 years without prior cardiovascular disease?

Key Points

To characterize longitudinal prescribing patterns of preventive cardiovascular medications between women experiencing nonsurgical versus surgical menopause to detect potential care disparities.
Retrospective multicenter cohort review using the TriNetX database from January 27, 2006, to January 27, 2026.
Identified 690,799 nonsurgical menopause patients and 28,473 surgical menopause patients, establishing propensity score–matched cohorts of 28,472 patients per group.
Assessed prescription rates of statins, antihypertensives, and diabetes medications over a 5-year follow-up period.
At 5 years, nonsurgical menopause patients had lower statin prescription rates than surgical menopause patients (6.0% vs 7.2%; OR, 1.22; 95% CI, 1.14-1.30; P <.0001).
Antihypertensive prescription rates at 5 years were lower in nonsurgical menopause patients than in surgical menopause patients (17.1% vs 21.9%; OR, 1.36; 95% CI, 1.31-1.42; P <.0001).
Diabetes medication prescriptions at 5 years were significantly lower for nonsurgical compared with surgical menopause patients (7.7% vs 10.1%; OR, 1.35; 95% CI, 1.27-1.43; P <.0001).

Study Design

Type

Cohort (n=719,272)

Multicenter

Yes

Structured PICO

Does surgical menopause compared with nonsurgical menopause increase the rate of prescriptions for statins, antihypertensive medications, and diabetes medications in midlife women aged 40 to 60 years without prior cardiovascular disease?

P

Population

719,272 women aged 40-60 years with surgical or nonsurgical menopause (56,944 after 1:1 propensity score matching, mean age 46.4 years), free of prior cardiovascular disease or baseline preventive cardiometabolic therapy, followed for 5 years.

E

Exposure

Surgical menopause (classified by bilateral oophorectomy, with the acquired absence of bilateral ovaries as the index event)

C

Comparator

Nonsurgical (natural) menopause (included if diagnosed with menopause or symptomatic premature menopause, with the first diagnosis as the index event), 1:1 propensity score-matched on age at index, race, and comorbidities (diabetes, hypertension, chronic kidney disease, body mass index, and hyperlipidemia)

O

Outcome

Rate of prescriptions for statins, antihypertensive medications, and diabetes medications over 5 years of follow-up (with interval results at 1 month, 3 months, 1 year, 3 years, and 5 years)

Main Result

Odds Ratio: 1.22 (95% CI 1.14–1.3)

Absolute Event Rate: 7.2% vs 6%

p-value: p=<0.0001

Women with nonsurgical menopause are prescribed statins, antihypertensives, and diabetes medications at significantly lower rates over 5 years than propensity score-matched women with surgical menopause, highlighting a potential gap in primary cardiovascular prevention for naturally menopausal women.

Limitations

Reliance on ICD-10 diagnostic coding in the TriNetX database, with likely undercoding of nonsurgical (natural) menopause.
Lack of matching or adjustment for specific vital signs (blood pressure) or laboratory values (lipids, blood glucose, HbA1c).
Evaluation of EHR prescription records rather than actual medication fill history, patient adherence, or guideline-based treatment eligibility.
Menopausal hormone therapy (MHT) was not excluded or adjusted for as a covariate, which may confound cardiometabolic risk and prescribing patterns.
Inability to differentiate between type 1 and type 2 diabetes or confirm specific clinical indications for prescribed medication classes.
Diagnoses are limited by the accuracy of ICD-10 coding in the electronic health record database, with potential undercoding of nonsurgical menopause leading to selection bias toward women seeking care for menopausal symptoms.
Did not match or adjust for specific vital signs (such as blood pressure) or laboratory values (including lipid measurements, blood glucose, or hemoglobin A1c), nor menopausal hormone therapy (MHT) use.
Evaluated prescription patterns rather than guideline-based treatment eligibility, as TriNetX lacks built-in CVD risk calculators.
Evaluated prescriptions recorded in the electronic health record rather than actual medication fill history, adherence, acceptance, discontinuation, or intolerance.
Some medications (such as beta-blockers, diuretics, SGLT2-i, and GLP-1 receptor agonists) have additional indications beyond hypertension and diabetes management, and the analysis did not differentiate between type 1 and type 2 diabetes.

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Implication

May signal undertreatment of CV risk factors after natural menopause; leaves open causal mechanisms and need for prospective trials before practice change.

Abstract

Objective: To characterize longitudinal prescribing patterns of preventive cardiovascular medications among women with nonsurgical menopause and women with surgical menopause to better identify potential differences in care. Patients and Methods: We conducted a retrospective multicenter review using TriNetX from January 27, 2006, to January 27, 2026 (TriNetX analyzes up to 20 years of data before the analysis date). Nonsurgical and surgical menopause patients were compared regarding statin, antihypertensive, and diabetes medication prescription rates over 5 years. Prescribing patterns were additionally analyzed based on medication classes. Results: A total of 690,799 nonsurgical menopause patients and 28,473 surgical menopause patients were queried. Nonsurgical menopausal women consistently had lower rates of statin (6.0%), antihypertensive (17.1%), and diabetes medications (7.7%) over 5 years than surgical menopause patients ( P <.0001). Conclusion: Surgical menopause patients had higher rates of statin, antihypertensive, and diabetes prescriptions than nonsurgical menopause patients matched by age and comorbidities. Providers should be cognizant of the interplay between menopause status and cardiovascular risk when prescribing preventive cardiovascular medications.

Discussion

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Cite This Study

Elizabeth L. Barrett-Connor (1997) conducted a cohort in Menopause (surgical via bilateral oophorectomy vs. nonsurgical natural/premature menopause) (n=719,272). Surgical menopause (bilateral oophorectomy) vs. Nonsurgical (natural) menopause was evaluated on Statin prescription rate at 5 years (co-primary with antihypertensive and diabetes medication prescription rates) (OR 1.22, 95% CI 1.14-1.30, p=<0.0001). Surgical menopause was associated with higher 5-year prescription rates of statins (7.2% vs 6.0%; OR 1.22), antihypertensives (21.9% vs 17.1%), and diabetes drugs (10.1% vs 7.7%) vs natural menopause.

synapsesocial.com/papers/6ad97fe000a2894e19c1a885 https://doi.org/10.1161/01.cir.95.1.252

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Sex Differences in Coronary Heart Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sex Differences in Coronary Heart Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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