Discussion
acute coronary heart syndrome, acute coronary syndrome
EVENTS, SECONDARY, EVENT, ACUTE CORONARY SYNDROME
This subanalysis from a randomized controlled trial showed no significant sex differences in secondary preventive target achievement for cardiovascular risk factors and medication use or for composite endpoint-free survival after MI, PCI or CABG. We found no sex differences between patients with hospital-based follow-up and patients with follow-up in the primary care service.Sex differences in presentation and in the management of acute coronary heart syndrome are well-described, but not well-understood [Hyun et al. and Lee et al. have described less use of secondary preventive medication and higher incidence of major adverse cardiovascular events after acute coronary syndrome in Australian women compared to their male counterparts [About 30% of all participants experienced a new major cardiovascular event (MACE) during the follow-up period (mean 5 years). This reiterates the importance of improving secondary preventive treatment after MI, PCI and/or CABG.The main strengths of this study are the inclusion of both patients with hospital-based and primary care-based follow-up and the low proportion of dropouts. Selection bias due to socioeconomical status is supposed to be minimal, given that patient charges in Norway are low and availability of healthcare services is independent of income level. Whether educational or other factors contribute to some degree of selection bias, require an analysis of patient characteristics among those who refused participation in the study, which was not available for us. The effects of healthcare provider-patient gender concordance/discordance on the treatment choices and results has been questioned in several studies, but the data is scarce and results far from conclusive and unambiguous [The study results may be influenced as well by smaller proportion of women than men participating in the study. We assume that the open design of the study implies awareness of participation, which might have influenced the behavior of participants. We also lacked an overview of the number of consultations and treatment measures at the primary care service.