Women Less Likely Than Men to Adhere to Post-ACS Medications: TEXTMEDS

Why It Matters

The lower adherence and risk‑factor control among women may translate into higher recurrent cardiovascular events and mortality, widening existing gender gaps in outcomes. Addressing socioeconomic determinants is essential for improving post‑ACS care equity.

Key Takeaways

• Women 46% adherent vs 54% men at 12 months
• Only 39% of women hit LDL <70 mg/dL vs 50% men
• Physical activity target met by 50% women vs 63% men
• Socioeconomic factors explain most gender adherence gap
• More comorbidities reduce adherence to cardioprotective meds

Pulse Analysis

Acute coronary syndrome (ACS) marks a pivotal moment in a patient’s cardiovascular journey, and the months that follow are critical for preventing recurrence. Clinical guidelines stress aggressive lipid lowering, blood‑pressure control, regular exercise, and a cocktail of cardioprotective drugs—including statins, beta‑blockers, aspirin, ACE inhibitors or ARBs, and P2Y12 inhibitors. Yet real‑world adherence remains stubbornly low, hovering around 50 % in most registries. Within this landscape, gender differences have emerged as a persistent blindspot, with women consistently receiving fewer prescriptions and reporting poorer compliance, a trend that threatens to erode the gains of modern secondary prevention.

The TEXTMEDS trial, a randomized study that used text‑message reminders to boost post‑ACS medication use in Australian hospitals, provides a granular look at these disparities. Among 1,379 participants—only 20.6 % women—adherence at six and twelve months was 52 % overall, but 46 % for women versus 54 % for men. Women were also less likely to achieve an LDL‑cholesterol level below 70 mg/dL (39 % vs 50 % of men) and to meet physical‑activity goals (50 % vs 63 %). Adjusting for age, ethnicity, and clinical factors preserved the gap, yet the difference vanished when socioeconomic variables such as income and education were added, highlighting the outsized role of social determinants.

These findings signal that closing the gender gap in secondary prevention will require more than generic reminders. Health systems must integrate socioeconomic screening into discharge planning, tailor education to address concerns about statin side effects, and simplify polypharmacy regimens for patients juggling multiple chronic conditions. Policymakers could incentivize community‑based support programs that alleviate caregiving burdens, a common barrier for women. As the evidence base grows, future trials should test gender‑responsive interventions that combine digital nudges with targeted social support, aiming to lift adherence rates and ultimately reduce recurrent cardiac events across both sexes.