1. The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study
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Valeria Raparelli, Marco Proietti, Giulio Francesco Romiti, Andrea Lenzi, Stefania Basili, The EVA Collaborative Group, Claudio Tiberti, Federica Panimolle, Andrea Isidori, Elisa Giannetta, Mary Anna Venneri, Laura Napoleone, Marta Novo, Silvia Quattrino, Simona Ceccarelli, Eleni Anastasiadou, Francesca Megiorni, Cinzia Marchese, Enrico Mangieri, Gaetano Tanzilli, Nicola Viceconte, Francesco Barillà, Carlo Gaudio, Vincenzo Paravati, Guglielmo Tellan, Evaristo Ettorre, Adriana Servello, Fabio Miraldi, Andrea Moretti, Alessandra Tanzilli, Piergiovanni Mazzonna, Suleyman Al Kindy, Riccardo Iorio, Martina Di Iorio, Gennaro Petriello, Laura Gioffrè, Eleonora Indolfi, Gaetano Pero, Nino Cocco, Loredana Iannetta, Sara Giannuzzi, Emilio Centaro, Sonia Cristina Sergi, Filippo Toriello, Eleonora Ruscio, Tommaso Todisco, Nicolò Sperduti, Giuseppe Santangelo, Giacomo Visioli, Marco Vano, Marco Borgi, Ludovica Maria Antonini, Silvia Robuffo, Claudia Tucci, Agostino Rossoni, Valeria Spugnardi, Annarita Vernile, Mariateresa Santoliquido, Verdiana Santori, Giulia Tosti, Fabrizio Recchia, Francesco Morricone, Roberto Scacciavillani, Alice Lipari, Andrea Zito, Floriana Testa, Giulia Ricci, Ilaria Vellucci, Marianna Vincenti, Silvia Pietropaolo, Camilla Scala, Nicolò Rubini, Marta Tomassi, Daria Amoroso, Lucia Stefanini, Simona Bartimoccia, Giovanni Talerico, Pasquale Pignatelli, Roberto Cangemi, Salvatore Minisola, Sergio Morelli, Antonio Fraioli, Silvia Nocchi, Mario Fontana, Sebastiano Filetti, Massimo Fiorilli, Danilo Toni, Anne Falcou, Louise Pilote, Tabeth Tsitsi Jiri, Muhammad Ahmer Wali, Amanpreet Kaur, Malik Elharram, Anna Rita Vestri, Patrizia Ferroni, Clara Crescioli, Cristina Antinozzi, Francesca Serena Pignataro, Tiziana Bellini, Alessandro Trentini, Roberto Carnevale, Cristina Nocella, Carlo Catalano, Iacopo Carbone, Nicola Galea, Giuliano Bertazzoni, Marianna Suppa, Antonello Rosa, Gioacchino Galardo, Maria Alessandroni, Lorena Cipollone, Alessandro Coppola, Mariangela Palladino, Giulio Illuminati, Fabrizio Consorti, Paola Mariani, Fabrizio Neri, Paolo Salis, Antonio Segatori, Laurent Tellini, and Gianluca Costabile
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sex ,gender ,diabetes ,medication adherence ,ischemic heart disease ,personality traits ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner.
- Published
- 2019
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