Another treatment gap: Restarting secondary prevention medications: The Women's Health Initiative

Jennifer G. Robinson, Robert Wallace, Monika M. Safford, Mary Pettinger, Barbara Cochrane, Marcia G. Ko, Mary Jo O'Sullivan, Kamal Masaki, Helen Petrovich

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Women's long-term patterns of evidence-based preventive medication use after a diagnosis of coronary heart disease have not been sufficiently studied. Methods: Postmenopausal women ages 50 to 79 years were eligible for randomization in the Women's Health Initiative's hormone trials if they met inclusion and exclusion criteria and were >80% adherent during a placebo-lead-in period and in the dietary modification trial if they were willing to follow a 20% fat diet. Those with adjudicated myocardial infarction or coronary revascularization after the baseline visit were included in the analysis (n = 2627). Baseline visits occurred between 1993 and 1998, then annually until the trials ended in 2002 through 2005; medication inventories were obtained at baseline and years 1, 3, 6, and 9. Results: Use at the first Women's Health Initiative visit after a coronary heart disease diagnosis increased over time for statins (49% to 72%; P < .0001), beta-blockers (49% to 62%; P = .003), and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers (ACEI/ARBs; 26%-43%; P < .0001). Aspirin use remained stable at 76% (P = .09). Once women reported using a statin, aspirin, or beta-blocker, 84% to 89% reported use at 1 or more subsequent visits, with slightly lower rates for ACEI/ARBS (76%). Statin, aspirin, beta-blocker, or ACEI/ARB use was reported at 2 or more consecutive visits by 57%, 66%, 48%, and 28%, respectively. These drugs were initiated or resumed at a later visit by 24%, 17%, 15%, and 17%, respectively, and were never used during the period of follow-up by 19%, 10%, 33%, and 49% respectively. Conclusions: Efforts to improve secondary prevention medication use should target both drug initiation and restarting drugs in patients who have discontinued them.

Original languageEnglish (US)
Pages (from-to)36-45
Number of pages10
JournalJournal of Clinical Lipidology
Issue number1
StatePublished - Jan 2010
Externally publishedYes


  • Adherence
  • Coronary heart disease
  • Secondary prevention
  • Statins
  • Women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Nutrition and Dietetics


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