{"id":"46089","type":"article","url":"https://hartvaat.nl/2026/04/09/sekseverschillen-in-secundaire-preventie-na-acs-vrouwen-halen-minder-vaak-hun-ld/","title":"Sekseverschillen in secundaire preventie na ACS: vrouwen halen minder vaak hun LDL-doel (TEXTMEDS)","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003856?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003856?rss=1","authors":["Mishra","S. R.","Marschner","S.","Min","H.","Mahendran","S.","Thiagalingam","A.","Poulter","R.","Redfern","J.","Brieger","D. B.","Thompson","P. L.","Hillis","G. S.","Collins","N.","Shetty","P.","McGrady","M.","Hamilton-Craig","C.","Kangaharan","N.","Atherton","J.","Maiorana","A.","Klimis","H.","Juergens","C.","Chow","C. K."],"significance":6,"published":"2026-07-23","source_date":"2026-04-09","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/secundaire-preventie-na-acs/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"Good risk-factor control and medication adherence after an acute coronary syndrome (ACS) help determine long-term prognosis, and sex plays a role. In this secondary analysis of the randomised TEXTMEDS trial (1,379 patients post-ACS, 79% male), sex differences in secondary-prevention targets were examined. Women were less likely to reach the LDL-cholesterol target (<1.8 mmol/L; aOR 0.61) and to exercise regularly (aOR 0.61), but more likely to achieve a healthy BMI (aOR 1.47). Women were also less adherent to medication (aOR 0.68), though this association weakened and lost significance after adjustment for socioeconomic factors. The findings argue for sex-sensitive strategies for risk-factor control and adherence to improve cardiovascular outcomes.","created":"2026-07-03T20:27:18Z","updated":"2026-07-04T19:09:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Goede risicofactorcontrole en medicatietrouw na een acuut coronair syndroom (ACS) bepalen mede de langetermijnprognose, en het geslacht speelt daarin een rol. In deze secundaire analyse van de gerandomiseerde TEXTMEDS-trial (1.379 patiënten na ACS, 79% man) werden sekseverschillen in secundaire-preventiedoelen onderzocht. Vrouwen haalden minder vaak het LDL-cholesteroldoel (<1,8 mmol/l; aOR 0,61) en bewogen minder regelmatig (aOR 0,61), maar bereikten vaker een gezond BMI (aOR 1,47). Vrouwen waren ook minder therapietrouw (aOR 0,68), al verzwakte dit verband en verloor het zijn significantie na correctie voor sociaaleconomische factoren. De bevindingen pleiten voor sekse-sensitieve strategieën voor risicofactorcontrole en therapietrouw om de cardiovasculaire uitkomsten te verbeteren.","abstract_original":"Introduction\n

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).

\n\nMethods\n

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.

\n\nResults\n

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).

\n\nConclusion\n

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.

\n\nTrial registration number\n

ACTRN12613000793718.

\n"}