Sex Differences in the Use and Discontinuation of Recommended Drugs in Secondary Ischemic Stroke Prevention: A Regional Registry-Based Analysis

Abstract

Introduction:

Stroke is the leading cause of death among women and the third among men. Few studies have explored sex differences in poststroke treatment compliance, and the results are in conflict. Only a few have assessed all recommended drugs, and none have been conducted in France. We evaluated the use of recommended drugs after ischemic stroke in France.

Patients and Methods:

This prospective cohort of adult ischemic stroke was conducted from 2019 to 2021 in Aquitaine, southwestern France, using data from the PAPASéPA project, that is, three data sources: the Aquitaine Stroke Observatory (ObA2) matched with the French reimbursement health care system (SNDS), and completed by ad hoc data. The use of antihypertensive drugs, lipid-lowering drugs, antiplatelet agents, and anticoagulants in the month following hospital discharge was evaluated using logistic regression models. Discontinuation of these drugs 1 year after stroke was estimated using Cox cause-specific models.

Results:

Of the 822 included patients, 45% were women. Postdischarge use of antihypertensive drugs, antiplatelet agents, and anticoagulants was not sex-dependent (adjusted odds ratio [aOR] of use in women compared with men aOR = 0.95, 95% confidence interval [CI] = [0.64–1.39], aOR = 0.95, 95% CI = [0.67–1.36], and aOR = 1.01, 95% CI = [0.70–1.45], respectively). However, women were less likely to receive lipid-lowering drugs (aOR = 0.69, 95% CI = [0.48–0.99]). Regardless of the drug, the 1-year discontinuation rate did not differ between the sexes.

Discussion and Conclusion:

Women were less likely to receive lipid-lowering drugs after an ischemic stroke, but the rate of drug discontinuation did not differ between men and women, regardless of the drug. In postischemic stroke, the prescription of lipid-lowering drugs in women is important for improving their cardiovascular health.