{
  "abstract": "Introduction Poor adherence to risk factor control and life-saving medications is a key factor affecting long-term patient prognosis. Evidence indicates that sex plays a significant role in the uptake of both pharmacological and non-pharmacological interventions, ultimately influencing long-term outcomes. This study aimed to quantify sex differences in risk factor management and medication adherence following acute coronary syndrome (ACS).Methods This is a secondary analysis of the TEXTMEDS randomised clinical trial - a single-blind, multicentre randomised controlled trial of patients post-ACS. We compared sex differences in achieving clinical and lifestyle targets for secondary prevention, namely blood pressure control (<140/90 mm Hg), low-density lipoprotein cholesterol (LDL-C) (<1.8 mmol/L), healthy body mass index (BMI) (<25 kg/m²), regular physical activity (Global Physical Activity Questionnaire score ≥600), smoking status and adherence to cardioprotective medications (aspirin, beta blockers, ACE/angiotensin receptor blockers, statins, antiplatelets), using adjusted logistic regression models. Medication adherence was defined as taking ≥80% of prescribed doses in the month prior to follow-up, across all five drug classes, unless contraindicated.Results Of 1379 patients (mean age 58.5±10.7 years; 1095 (79.4%) male), females were less likely than men to achieve LDL-C targets (adjusted OR (aOR): 0.61, 95% CI 0.45 to 0.82) and engage in regular physical activity (aOR: 0.61, CI 0.47 to 0.80), but more likely to achieve a healthy BMI (aOR: 1.47, CI 1.04 to 2.06). Female patients are less likely to adhere to their medication compared with male counterparts (aOR: 0.68, CI 0.50 to 0.92). However, this association weakened and lost statistical significance after further adjustment for socio-economic factors (aOR: 0.71, CI 0.50 to 1.03). There were no significant interactions between sociodemographic or clinical factors and sex in relation to overall medication adherence (P-interactions >0.05).Conclusion This study reveals that female patients are less likely to achieve LDL-C targets and engage in physical activity but more likely to maintain a healthy BMI. Although females showed lower medication adherence, this association weakened after adjusting for socio-economic factors. These findings highlight the importance of sex-sensitive strategies focusing on risk factor control and medication adherence for improving cardiovascular health outcomes.Trial registration number ACTRN12613000793718.",
  "authors": [
    {
      "affiliations": [
        "The University of Sydney Westmead Applied Research Centre, Westmead, New South Wales, Australia"
      ],
      "name": "Shiva Raj Mishra"
    },
    {
      "affiliations": [
        "Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia"
      ],
      "name": "Simone Marschner"
    },
    {
      "affiliations": [
        "Westmead Applied Research Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Haeri Min"
    },
    {
      "affiliations": [
        "The University of Sydney, Sydney, New South Wales, Australia",
        "Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia"
      ],
      "name": "Shehane Mahendran"
    },
    {
      "affiliations": [
        "Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Aravinda Thiagalingam"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia"
      ],
      "name": "Rohan Poulter"
    },
    {
      "affiliations": [
        "Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia",
        "The George Institute for Global Health, Sydney, New South Wales, Australia"
      ],
      "name": "Julie Redfern"
    },
    {
      "affiliations": [
        "Cardiology, Concord Hospital, Sydney, New South Wales, Australia"
      ],
      "name": "David B Brieger"
    },
    {
      "affiliations": [
        "Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia"
      ],
      "name": "Peter L Thompson"
    },
    {
      "affiliations": [
        "Cardiology, Department of Cardiology, Royal Perth Hospital, Perth, Australia, Perth, Western Australia, Australia"
      ],
      "name": "Graham S Hillis"
    },
    {
      "affiliations": [
        "Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia",
        "The University of Newcastle, Callaghan, New South Wales, Australia"
      ],
      "name": "Nicholas Collins"
    },
    {
      "affiliations": [
        "Wollongong Hospital, South Coast Mail Centre, New South Wales, Australia"
      ],
      "name": "Pratap Shetty"
    },
    {
      "affiliations": [
        "Epidemiology and Preventive Medicine, Monash University, Melbourne, New South Wales, Australia"
      ],
      "name": "Michele McGrady"
    },
    {
      "affiliations": [
        "Department of Cardiology, Prince Charles Hospital, Merthyr Tydfil, UK"
      ],
      "name": "Christian Hamilton-Craig"
    },
    {
      "affiliations": [
        "Department of Cardiology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia"
      ],
      "name": "Nadarajah Kangaharan"
    },
    {
      "affiliations": [
        "Cardiology, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia"
      ],
      "name": "John Atherton"
    },
    {
      "affiliations": [
        "Allied Health Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia",
        "Curtin University, Perth, Western Australia, Australia"
      ],
      "name": "Andrew Maiorana"
    },
    {
      "affiliations": [
        "Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia"
      ],
      "name": "Harry Klimis"
    },
    {
      "affiliations": [
        "The University of New South Wales, Sydney, New South Wales, Australia",
        "Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia"
      ],
      "name": "Craig Juergens"
    },
    {
      "affiliations": [
        "Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia",
        "The George Institute for Global Health, Sydney, New South Wales, Australia"
      ],
      "name": "Clara K Chow"
    }
  ],
  "title": "Sex differences in risk factor control and medication adherence post-ACS: insights from the TEXTMEDS randomised clinical trial",
  "uid": "214ce926-d132-5392-8612-eb3f1e72fba5"
}