Women, particularly Mexican American women, may be up to three times more likely compared with men to report nonadherence to cholesterol-lowering medications after a first-ever ischemic stroke, according to a recent study.
In the study, published in the Journal of the American Heart Association, investigators conducted a study examining sex differences in medication adherence among patients who experienced first-ever ischemic stroke. Using data from the Brain Attack Surveillance in Corpus Christi project, the investigators analyzed adherence to secondary stroke prevention medications at 90 days poststroke in a cohort of 1,324 participants, 48.4% of whom were women and 58.0% of whom were Mexican American.
Self-reported adherence was assessed for antihypertensives, cholesterol-lowering drugs, antiplatelets, and anticoagulants. Adherence was defined as never or rarely missing a dose in a typical week. Modified Poisson models were used to calculate prevalence ratios (PR), both unadjusted and adjusted for demographic, social, health system–related, lifestyle, health condition, prestroke, and stroke-related factors.
The study found that women were more likely than men to report nonadherence to cholesterol-lowering drugs (PR = 1.80, 95% confidence interval [CI] = 1.14–2.84) and antiplatelets (PR = 1.53, 95% CI = 1.003–2.34). Adjustments for obesity attenuated these sex differences, while controlling for age, marital status, access to care, smoking, and alcohol consumption accentuated them. No significant sex differences were observed in adherence to antihypertensives (PR = 1.31, 95% CI = 0.82–2.09) or overall adherence (PR = 1.34, 95% CI = 0.95–1.90).
Ethnic disparities were evident, with Mexican American women three times more likely than men to report nonadherence to cholesterol-lowering drugs (PR = 3.00, 95% CI = 1.65–5.48) compared with non-Hispanic White participants (PR = 1.30, 95% CI = 0.52–3.27, Pinteraction = .054). No statistically significant ethnic differences were observed for antihypertensives or antiplatelets.
Adjusting for obesity, a condition more common in women, lessened the observed sex disparities, indicating that strategies to enhance medication adherence may benefit from focusing on women with overweight or obesity. Notably, data for anticoagulants were not included in the subsequent results as a result of the small sample size.
The findings indicated that addressing social, lifestyle, and access-related factors may improve adherence. Additional focus may be needed for Mexican American women, women with obesity, and men with risk factors such as unhealthy lifestyles or limited health care access. These results underscored the need for further research into strategies to address medication nonadherence and its impact on recurrent stroke risk.
Full disclosures can be found in the published study.