Abstract Aims Women are less likely to receive lipid-lowering therapy(LLT) after acute myocardial infarction(AMI). We analysed whether this under-prescription currently persists and has an impact on long-term outcomes. Methods The FAST-MI program consists in nationwide registries including all patients admitted for AMI ≤48 hours from onset over a one-month period in 2005, 2010 and 2015, with long-term follow-up. This analysis focused on high-intensity LLT (atorvastatin≥40 mg or equivalent, or any combination of statin and ezetimibe) in women and men. Results Women accounted for 28% (N=3547) of the 12659 patients. At discharge, high-intensity LLT was significantly less prescribed in women (54% vs. 68% in men, p<0.001, adjusted OR 0.78[95% CI 0.71-0.87]), a trend that did not improve over time: 2005, 25% versus 35% (P=0.14); 2010, 66% versus 79% (P<0.001); 2015, 67% versus 79.5% (P=0.001). In contrast, female sex was not associated with a lack of other recommended treatments at discharge: beta-blockers (adjusted OR 0.98[95% CI 0.88-1.10], P=0.78), or renin-angiotensin blockers (adjusted OR 0.94[95% CI 0.85-1.03], P=0.18). High-intensity LLT at discharge was significantly associated with improved five-year survival and infarct- and stroke-free survival in women (adjusted HR 0.74[95%CI 0.64-0.86], P<0.001 and adjusted HR: 0.81[95% CI: 0.74−0.89]; P<0.001, respectively). Similar results were found using a propensity score-matched analysis (HR for 5-year survival in women with high intensity LLT: 0.82[95%CI 0.70-0.98], P=0.03). Conclusion Women suffer from a bias regarding prescription of high-intensity LLT after AMI, which did not attenuate between 2005 and 2015, with potential consequences on both survival and risk of cardiovascular events.