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Pocketbook and mental health factors disproportionately affect women's care for premature atherosclerotic cardiovascular disease (ASCVD), a large cohort study showed.

Women with premature ASCVD were more likely to report being clinically depressed compared with men (OR 1.73, 95% CI 1.41-2.14) after adjustment for other factors, reported Salim Virani, MD, PhD, of the Michael E. DeBakey Veterans Affairs Medical Center in Houston, and colleagues.

In addition, women were 4.5-fold more likely to have skipped seeing a doctor due to cost (P<0.001) and had more cost-related medication nonadherence versus men (OR 1.42, 95% CI 1.11-1.82), they noted in .

This was the case despite the fact that more women reported that they had healthcare coverage compared with men (85.3% vs 80.8%, P=0.04), as well as a primary care physician (84.2% vs 75.7%, respectively, P<0.001).

"These findings suggest that while women might be more likely to seek routine care, they may face barriers to accessing this care," the researchers suggested. For example, they wrote, "despite having health care coverage, it may be more difficult for women to see a clinician or take a prescribed medication compared with men because of copays or other expenses."

As medication costs are only expected to continue to rise, potentially worsening these disparities, Virani's group concluded, "Interventions addressing mental health and out-of-pocket costs are needed in adults with premature ASCVD."

One practical implication for clinical practice, they noted, is to incorporate mental well-being screening into all cardiovascular care visits.

"Addressing mental well-being as an integral part of management of ASCVD in young adults is of paramount importance," they wrote.

Advocating for policy-level changes would help too, Virani and colleagues argued.

The retrospective cohort included 748,090 U.S. adults ages 18 to 55 years who participated in the , the CDC's health-related telephone survey, for the period from 2016 to 2019.

However, analysis was limited to the 28,522 (3.3%) who self-reported coronary heart disease, myocardial infarction, or stroke and were thus deemed to have premature ASCVD. Among them, 47.0% were women.

Other sex-based disparities seen in the study were that the women were more likely to report overall poor physical health (OR 1.39, 95% CI 1.09-1.78), but less likely to report key risk factors -- hypertension, hyperlipidemia, and diabetes.

They were less likely than men in the cohort to endorse having received emotional support but also less likely to be dissatisfied with their quality of life.

While more of the women in the premature ASCVD group were Black and had lower income levels, the findings were "directionally similar" in sensitivity analyses stratified by , Virani and colleagues noted.

Limitations to the study included its cross-sectional design, which precluded determining causality and directionality in the findings. "Whether poor physical and mental health was present before the diagnoses [of] ASCVD or developed as a result of ASCVD cannot be ascertained by our data," the researchers acknowledged.

Another limitation was the possibility of measurement error and response bias from its reliance on self-reporting. For example, survey respondents with "self-reported reduced health status may be selectively driving our findings, and our results could be reflective of this bias," the group added.

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