AUTHOR=Raparelli Valeria , Proietti Marco , Romiti Giulio Francesco , Lenzi Andrea , Basili Stefania , The EVA Collaborative Group , Tiberti Claudio , Panimolle Federica , Isidori Andrea , Giannetta Elisa , Venneri Mary Anna , Napoleone Laura , Novo Marta , Quattrino Silvia , Ceccarelli Simona , Anastasiadou Eleni , Megiorni Francesca , Marchese Cinzia , Mangieri Enrico , Tanzilli Gaetano , Viceconte Nicola , Barillà Francesco , Gaudio Carlo , Paravati Vincenzo , Tellan Guglielmo , Ettorre Evaristo , Servello Adriana , Miraldi Fabio , Moretti Andrea , Tanzilli Alessandra , Mazzonna Piergiovanni , Kindy Suleyman Al , Iorio Riccardo , Iorio Martina Di , Petriello Gennaro , Gioffrè Laura , Indolfi Eleonora , Pero Gaetano , Cocco Nino , Iannetta Loredana , Giannuzzi Sara , Centaro Emilio , Sergi Sonia Cristina , Romiti Giulio Francesco , Toriello Filippo , Ruscio Eleonora , Todisco Tommaso , Sperduti Nicolò , Santangelo Giuseppe , Visioli Giacomo , Vano Marco , Borgi Marco , Antonini Ludovica Maria , Robuffo Silvia , Tucci Claudia , Rossoni Agostino , Spugnardi Valeria , Vernile Annarita , Santoliquido Mariateresa , Santori Verdiana , Tosti Giulia , Recchia Fabrizio , Morricone Francesco , Scacciavillani Roberto , Lipari Alice , Zito Andrea , Testa Floriana , Ricci Giulia , Vellucci Ilaria , Vincenti Marianna , Pietropaolo Silvia , Scala Camilla , Rubini Nicolò , Tomassi Marta , Amoroso Daria , Stefanini Lucia , Bartimoccia Simona , Talerico Giovanni , Pignatelli Pasquale , Cangemi Roberto , Minisola Salvatore , Morelli Sergio , Fraioli Antonio , Nocchi Silvia , Fontana Mario , Filetti Sebastiano , Fiorilli Massimo , Toni Danilo , Falcou Anne , Pilote Louise , Jiri Tabeth Tsitsi , Wali Muhammad Ahmer , Kaur Amanpreet , Elharram Malik , Vestri Anna Rita , Ferroni Patrizia , Crescioli Clara , Antinozzi Cristina , Pignataro Francesca Serena , Bellini Tiziana , Trentini Alessandro , Carnevale Roberto , Nocella Cristina , Catalano Carlo , Carbone Iacopo , Galea Nicola , Bertazzoni Giuliano , Suppa Marianna , Rosa Antonello , Galardo Gioacchino , Alessandroni Maria , Cipollone Lorena , Coppola Alessandro , Palladino Mariangela , Illuminati Giulio , Consorti Fabrizio , Mariani Paola , Neri Fabrizio , Salis Paolo , Segatori Antonio , Tellini Laurent , Costabile Gianluca
TITLE=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
JOURNAL=Frontiers in Endocrinology
VOLUME=10
YEAR=2019
URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2019.00107
DOI=10.3389/fendo.2019.00107
ISSN=1664-2392
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.