Abstract 14935: Are Women With Cardiovascular Disease Less Likely to Receive Evidence Based Statin Therapy Compared With Men? An Analysis From a National Cohort
OBJECTIVES: Studies have shown gender disparities in cholesterol care in cardiovascular disease (CVD) patients with women being less likely than men to have low-density-lipoprotein-cholesterol (LDL-C) levels <100 mg/dL. Whether this reflects a less evidence-based use of statin or high-dose statins for secondary prevention is unknown.
Methods: We used a national database of 959161 CVD (ischemic heart disease, peripheral arterial disease, ischemic stroke) patients who received care in 130 Veterans Health Administration facilities between October 1, 2010 to September 30, 2011 to identify the proportion of male and female CVD patients receiving any statin and the subset of those on high-dose statins (≥ 40 mg atorvastatin, ≥ 20 mg rosuvastatin, 80 mg simvastatin). We performed multivariate hierarchical logistic regression adjusting for covariates and for facility-level patient clustering to identify whether female gender was independently associated with a lower receipt of any statin or high-dose statin therapy.
RESULTS: The cohort included 13,371 women. Women with CVD were less likely than men to receive statins (57.6% vs. 64.8% for women and men, respectively; p <.0001) or high-dose statins (21.1% vs. 23.6% for women and men, respectively; p <.0001). Mean LDL-C (99 vs.85 mg/dL) and non-high-density lipoprotein cholesterol (128 vs. 112 mg/dL) levels were higher in women compared with men (p<0.0001 for both comparisons). In fully adjusted models (table), female gender was independently associated with a lower likelihood of receiving statins or high-dose statins.
Conclusion: Females are less likely to receive evidence-based statin therapy compared with males, although, the use of statin and high-dose statin remains low in both genders for secondary prevention. These results highlight areas for quality improvement especially if the forthcoming cholesterol guidelines adopt a “statin dose-based approach” in place of the current “treat-to-target” approach.
- © 2013 by American Heart Association, Inc.