A new analysis of the TEXTMEDS trial reveals meaningful gaps in how men and women manage cardiovascular health after acute coronary syndromes.
After a heart attack or other acute coronary syndrome (ACS), sticking to medications is critical — but a new study shows women are doing so at notably lower rates than men. The finding, published in Open Heart, comes from a secondary analysis of TEXTMEDS, a randomized clinical trial that tested whether text-message reminders could improve medication adherence after ACS in Australian patients.
The numbers
Among 1,379 participants tracked for 12 months, just 46% of women reported taking all five recommended heart medications — compared to 54% of men. The gap held across a range of drugs, including statins, beta-blockers, aspirin, ACE inhibitors, and P2Y12 inhibitors.
Women were also less likely to meet the recommended LDL-cholesterol target of under 70 mg/dL (39% vs. nearly 50% of men), and less likely to achieve regular physical activity goals (50% vs. 63%). On one measure, however, women came out ahead: they were more likely than men to maintain a healthy body mass index.
Socioeconomics as the hidden variable
One of the study's most important findings was what happened when researchers adjusted for socioeconomic factors like income and education: the adherence gap between men and women largely disappeared. The one exception was statins, where women remained significantly less likely to adhere even after full adjustment.
"When we accounted for socioeconomic factors like income and education, the difference between men and women largely disappeared, suggesting socioeconomic factors explain this relationship to some extent," said lead investigator Shiva Raj Mishra, PhD, of the University of Sydney.
As for the statin gap specifically, researchers point to several possible explanations: side-effect concerns, an underestimation of personal cardiac risk, and competing social priorities such as caregiving responsibilities.
A broader problem — for everyone
The study also underscores that medication adherence after ACS is low across the board. Overall, just over half of all patients — men and women combined — were consistently taking all five cardioprotective medications at 6 and 12 months. Patients with more comorbidities fared even worse, likely because managing multiple conditions simultaneously makes complex medication regimens harder to follow.
"Just knowing and having a serious cardiac event alone is clearly not sufficient as an intervention," said Mishra. "More is needed to address this."
"Medical adherence is important and difficult to achieve for many patients, and even more so for women compared to men. We should always be asking about medical adherence after ACS, especially among our patients with socioeconomic barriers to care."
— Clara Chow, MBBS, PhD, University of Sydney
Sources
Mishra SR et al. Open Heart, 2026. TEXTMEDS randomized clinical trial.
O'Riordan M. "Women Less Likely Than Men to Adhere to Post-ACS Medications: TEXTMEDS." TCTMD, April 13, 2026.
