Sex Differences in Prescription, Initiation, and Discontinuation of Secondary Prevention Medications After Stroke.

Abstract

Background: Women less frequently receive secondary prevention medications at discharge poststroke than men. It is unclear whether similar sex differences exist in the long term poststroke, after accounting for age and clinical characteristics. We aimed to evaluate sex differences in medication prescription, initiation, and discontinuation poststroke or transient ischemic attack.

Methods: A retrospective cohort study using person-level linked data from the Australian Stroke Clinical Registry (42 hospitals; Victoria and Queensland; 2012-2016). We included all adults with first-ever ischemic stroke, intracerebral hemorrhage, or transient ischemic attack who survived >60 days post-discharge. For each major class of secondary prevention medication (antihypertensive, antithrombotic, or lipid lowering), we evaluated sex differences in prescription at hospital discharge, initiation within 60 days, and discontinuation within 2 years post-discharge. Sex differences were assessed using multivariable models, adjusted for sociodemographics and comorbidities. Where effect modification by age was found (P_interaction≤0.05), age-specific odds ratios were reported.

Results: Among 8108 women (median age, 74.3 years) and 10 344 men (median age, 70.5 years) with first-ever stroke (≈8% intracerebral hemorrhage) or transient ischemic attack, women were less likely to be prescribed antihypertensive medications on discharge (odds ratio, 0.82 [95% CI, 0.74-0.91]). Women were less likely to initiate antihypertensive (odds ratio, 0.76 [95% CI, 0.69-0.84]) and antithrombotic (odds ratio, 0.89 [95% CI, 0.82-0.96]) medications within 60 days than men. While there was no overall difference in discontinuation between men and women, interactions were observed with age (P_interaction, all <0.002). Younger women (aged <45 years) and older women (aged >90 years) were more likely to discontinue secondary prevention medications than men of equivalent age.

Conclusions: Sex differences exist for prescription, initiation, and discontinuation of secondary prevention medications poststroke. With many sex differences being age specific, there is a critical need for targeted interventions to improve prevention medication use in these patient subgroups.