Nationwide initiation of cardiovascular risk treatments during the COVID-19 pandemic in France: Women on a slippery slope?

INTRODUCTION: During the COVID-19 pandemic, healthcare use has been challenged and several implications regarding the incidence and management of cardiovascular diseases and their risk factors were found. OBJECTIVE: This study examines time trends in the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population. METHOD: For each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for the medications of interest but no reimbursement in the previous 12 months. We computed crude and age-standardized rates along with incidence rate ratios (IRRs) between 2017–2019 and respectively 2020 and 2021 using Poisson regression adjusted for age and 2017–2019-time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists. RESULTS: In 2020, IRR significantly decreased for initiations of antihypertensives (−11%), lipid-lowering drugs (−5%), oral anticoagulants in atrial fibrillation (−9%), and smoking cessation medications (−52%) compared to 2017–2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017–2019 showed an increase in the initiation of lipid-lowering drugs (+12%) but even lower rates for the other medications, particularly in women. Besides, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4% and 7.4%, respectively, with a higher decrease observed in those over 65 years and a greater use of teleconsultations in women. CONCLUSION: The COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65 years.