Cardiac medication use in patients with suspected ischaemia without obstructive coronary arteries: Sex differences and psychological distress

P.M.C. Mommersteeg*, J.E. Roeters Van Lennep, J.W.C.M. Widdershoven

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background
Ischaemia without obstructive coronary arteries (INOCA) is more prevalent in women and associated with psychological distress. Pharmacological treatment goals are angina relief and cardiovascular risk management. The present study aims to examine sex differences in cardiac and non-cardiac medication use, as well as medication and sex differences related to consistent psychological distress in patients with suspected INOCA.

Design
A TweeSteden mild stenosis observational cohort study in patients with suspected INOCA as detected by ischaemic reason for referral and non-obstructive arteries based on coronary angiography or computed tomography.

Methods
Medication documented in the hospital records of 488 patients (53% women) was coded as angina relief medication, blood-pressure-lowering medication, antithrombotics, statins, and non-cardiac medication, using the Anatomical Therapeutic Chemical code. Depressive symptoms and anxiety were recoded as ‘consistent distress’ (above the cut-off score for depression and anxiety on validated questionnaires), ‘inconsistent distress’ (above the cut-off for depression or anxiety) or ‘no distress’ (below the cut-off).

Results
No sex differences were observed in cardiac medication use. Women used anxiolytic benzodiazepines more often (12% vs 4%, p = 0.002) compared to men. Consistent distress was more prevalent in women (22% vs 15%, p = 0.004) and was related to the use of more angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and diuretics in women and to calcium antagonist use as well as lower adherence levels in men. Women who reported chest pain more often received angina relief medication and blood-pressure-lowering medication than men.

Conclusion
No sex differences were observed in cardiac medication use in patients with suspected INOCA. Psychological distress may reflect hypertension and subsequent medication use in women, and experiencing chest pain and subsequent medication use in men.
Original languageEnglish
Number of pages8
JournalNetherlands Heart Journal
DOIs
Publication statusE-pub ahead of print - 2021

Keywords

  • Anxiety
  • CLINICAL-OUTCOMES
  • Depression
  • GENDER-DIFFERENCES
  • HEART-DISEASE
  • Ischaemia without obstructive coronary arteries
  • Ischaemic heart disease
  • Medication use
  • PERSONALITY
  • RISKS
  • Sex differences

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