(184) Management of cardiovascular risk in women with and without menopausal symptoms: a real-world depiction of clinical practice in the UK and France

Publication Number: 845

Background: The menopausal transition is a period of detrimental changes in several cardiometabolic risk factors for women. The 2021 European Society of Cardiology (ESC) consensus for cardiovascular health management during menopause states that clinicians should intensify the detection of hypertension in women and assess lipid levels and blood pressure (BP) during the transition.

Objectives: To investigate real-world clinical practice of menopause management in the UK and France and adherence to ESC recommendations for cardiovascular health management during menopause.

Methods: We used the THIN database, a European database of anonymized electronic health records collected from primary care. Women aged 40-59 years with menopausal symptoms and one year of medical history pre- and post-diagnosis were included. 26,324 patients in the UK and 43,151 in France were eligible for analysis. Key outcomes included: number of primary care physician (PCP) visits, BP measurements, blood lipid labs, antihypertensive and lipid-lowering prescriptions and changes in these outcomes pre- and post-diagnosis. Outcomes were presented as means and standard deviations. Statistical significance of the change between the pre- and post-diagnosis states were tested using a 2-sided paired t test with an alpha level of 0.05.

Results: The number of PCP visits in the increased from an average of 2.23 visits (SD: 2.34) in the year pre-diagnosis to 2.66 visits (SD: 2.48) in the year post-diagnosis (p-value < 0.01) in the UK and from an average of 3.28 visits (SD: 3.69) visits pre-diagnosis to 4.74 visits (SD: 4.10) post-diagnosis (p-value < 0.01) in France. In both countries, younger women tended to go to the PCP more frequently than older women. Amongst women in the youngest age group (40-44 years) who did not see the doctor at all in the year pre-diagnosis, about 80% changed their health-seeking behavior and visited the doctor at least once in the year post-diagnosis in the UK and France. There was an increase in the average number of BP measurements performed per person from pre- to post-diagnosis (0.87 vs 1.17 in the UK and 0.48 vs 0.75 in France) as well as lipid labs (0.95 vs 1.21 in the UK and 0.35 vs 0.45 in France). The average number of antihypertensive or lipid-lowering medications prescribed per person did not change significantly.

Conclusions: The transition from premenopausal to menopausal witnesses an increase in PCP visits; however this is not reflected in the opportunity to measure and address all cardiovascular risk factors in this group of women who are at elevated cardiovascular risk.