Elevated Risk Profile of Women in Secondary Prevention of Coronary Artery Disease: A 6-Year Survey of 117,913 Patients

Background and Aims: The prognosis of female patients after acute coronary syndrome (ACS) has been shown to be inferior to that of male patients. Little is known about gender differences during the secondary prevention phase. Methods: After ACS, 117,913 patients (30.7% female) were enrolled in two large-scale German registries from 2000 to 2005 during phase II cardiac rehabilitation (CR). Demographic parameters, reperfusion strategies, cardiovascular risk factors, exercise capacity, and medication use at admission and discharge were assessed. Temporary changes ( trends) and gender-specific differences were determined. Results: Compared to 2000, patients in 2005 were significantly older (females: 66.4 vs. 68.0 years; males: 62.3 vs. 63.3 years; p = 0.001) and had a higher body mass index (BMI) (females: 27.7 vs. 28.6 kg/m(2); males: 27.6 vs. 28.1 kg/m(2), in 2000 and 2005, respectively, p<0.001). Target blood pressure <140/90mm Hg at discharge was obtained in a smaller proportion of women than men (81.0 vs. 83.0%, p<0.001). Low-density lipoprotein cholesterol (LDL-C) levels at discharge were significantly higher in female patients (95.0 vs. 93.2 mg/dL, p<0.001); 80.9% of female vs. 83.8% of male patients achieved a target fasting glucose <126 mg/dL during the CR (p<0.001). Large between-center variability was noted for age, total cholesterol at entry, and exercise capacity at entry and discharge. Conclusions: Although control of cardiovascular risk factors has improved in both genders, over a recent 6-year period, female patients compared with males were less likely to achieve target values for blood pressure, fasting glucose, and lipid values in the early period after acute coronary events.