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Per la prevenzione cardiovascolare uomini e donne non sono uguali

E' dagli anni '90 che è stato segnalato che alle donne si presta poca attenzione per la correzione dei fattori di rischio coronarico. Sono passati molti anni e si sono accumulate prove che la terapia preventiva, quando attuata, comporta gli stessi benefici nell'uomo e nella donna. Ma poco è cambiato. Nello studio sono stati inclusi 2747 pazienti ad alto rischio (1341 donne e 1406 uomini). Di questi, 852 uomini e 694 donne non erano in terapia con statine, ma il 51% degli uomini aveva raggiunto ugualmente l'obiettivo terapeutico per il colesterolo LDL, contro solo il 41% delle donne. Dei 554 uomini in terapia con statine, il 53% aveva raggiunto l'obiettivo, contro il 54% delle 620 donne. Nel complesso, le donne con colesterolo LDL all'obiettivo terapeutico erano il 47% contro il 52% degli uomini. La più bassa percentuale delle donne all'obiettivo è evidentemente giustificata dalla minore prescrizione di statine.

Comparison of Adherence to Guideline-Based Cholesterol Treatment Goals in Men Versus Women

Schoen MW, Tabak RG, Salas J, Scherrer JF, Buckhold FR

Am J Cardiol 2016;117:48-53

Studies show women do not receive aggressive cardiovascular interventions and may not be given guideline-based treatment to reduce cardiac events. We describe cholesterol treatment in an academic practice of family and internal medicine physicians to understand factors associated with achievement of guideline-based treatment goals in women compared with men. Primary care patients aged 40 to 75 years were included if they were prescribed a statin, had a Framingham risk score of = 10%, had diabetes, or had atherosclerotic cardiovascular disease. Patients were classified into Adult Treatment Panel III categories and assessed to whether they were in compliance with Adult Treatment Panel III guidelines. Odds ratios of goal adherence between women and men were calculated, and a multivariate model for goal achievement was created. In 2,747 patients, women were less likely to achieve cholesterol goals (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.70 to 0.95) despite having more prescriptions for statins (48% vs 39%, p <0.001). More women than men failed to reach low-density lipoprotein goals because they were not prescribed a statin (OR 0.69; 95% CI 0.56 to 0.85) and women on high-intensity statins were less likely than men to achieve goals (OR 0.51; 95% CI 0.27 to 0.96). In all patients, diabetes was associated with nonattainment of cholesterol goals, but in high-risk women, the presence of diabetes improved goal achievement. In conclusion, women achieved guideline-based cholesterol recommendations at a lower rate than men, even when individual goals are considered.

Am J Cardiol 2016;117:48-53