Available online 15 October 2023

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States and worldwide. Medical management of known modifiable risk factors such as dyslipidemia, hypertension, and diabetes is a key aspect to its treatment. Unfortunately, there are significant sex-based differences in the treatment of ASCVD that result in poor medical management and worse clinical outcomes. The objective of this systematic review is to summarize known disparities in the medical management of ASCVD in women. We included prior studies with specific sex- and gender-based analyses regarding the medical treatment of three major disease entities within ASCVD: cerebrovascular disease, coronary artery disease and peripheral artery disease. A total of 43 articles met inclusion criteria. In our analysis, we found that women were less likely to receive appropriate treatment of dyslipidemia or be prescribed antithrombotic medications. However, treatment differences for diabetes and hypertension by sex were not as clearly represented in the included studies. In addition to rectifying these disparities in the medical management of ASCVD, this systematic review highlights the need to address larger issues such as underrepresentation of women in clinical trials, decreased access to care, and underdiagnosis of ASCVD to improve overall care for women.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in the United States and worldwide1,2. ASCVD involves 3 main vascular pathologies: cerebrovascular, peripheral, and coronary artery disease. Controlling modifiable risk factors remains the mainstay of current medical therapy and has been shown to significantly reduce ASCVD-related mortality3. Established modifiable risk factors include hypertension, dyslipidemia, diabetes, and smoking2. In the last 15 years,

This study followed the principles of the updated 2020 PRISMA Guidelines for systematic reviews and meta-analyses20. PubMed, Scopus and EMBASE databases were searched from their inception to June 2023 to identify articles relevant to the topic of this review. We considered eligible all studies analyzing disparities in the medical management of atherosclerosis and/or its risk factors. Of note, studies describing either sex or gender disparities were included while acknowledging that sex and

From a total pool of 43 articles selected for this manuscript, 4 are randomized controlled trials (RCT), 32 are cohort studies, 3 are case-control, 3 are cross-sectional and 1 is a pragmatic randomized trial.

Medical management that targets known modifiable risk factors is the cornerstone of both primary and secondary prevention of ASCVD. Furthermore, it has been shown to decrease rates of major cardiovascular events including MI, acute limb ischemia, and stroke and is thus recommended by most major societies in the management of patients with or at risk of ASCVD51-54. Therefore, assuring appropriate administration and compliance with medications is critical in patients with ASCVD and known to

To date, this is the only systematic review to comprehensively address medical management of ASCVD and assess sex-based differences in its treatment based off the primary pillars of non-interventional management of ASCVD: the use of medications for treatment of dyslipidemia, hypertension, diabetes, and antithrombosis/anticoagulation. Reasons for differences in medical management of women with ASCVD are complex and rooted in factors spanning individual to societal contexts. However, there are

1. Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS. Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal. Journal of the American Board of Family Medicine: JABFM. Nov-Dec 2019;32(6):807-817.

2. Fan J, Watanabe T. Atherosclerosis: Known and unknown. Pathology international. Mar 2022;72(3):151-160.

3. Rodriguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenreich PA. Association of Statin Adherence With Mortality in Patients With

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2023 Published by Elsevier Inc.