Abstract 17360: Four Factors Explain Most of the Gender Disparity in Statin Therapy
Despite well documented gender disparities in statin therapy, the reasons underlying these differences remain obscure. Applying natural language processing to a retrospective cohort of 24,338 patients with coronary artery disease (CAD) treated in primary care practices (PCP) affiliated with two academic medical centers between 01/01/2000 and 12/31/2011, we studied contribution of smoking, age, cardiologist evaluation and adverse statin reactions to gender differences in statin use.
Two thirds of the patients were men (Table); 85.6% received statins during the study period and 69.7% had persistent statin therapy (active statin prescription at the last PCP visit). Women were less likely than men to have been treated with a statin but equally likely to have persistent statin therapy after statin initiation. Women were older, less likely to have ever smoked, less likely to have been seen by a cardiologist and more likely to have reported an adverse reaction to a statin.
In multivariable analysis of all subjects, patients with history of smoking (OR 1.304), younger age (OR 1.016), or cardiologist evaluation (OR 1.797) were more likely (p < 0.001 for all) to have persistent statin therapy. Direct estimations of the effect of the differences in joint distributions of the covariates between men and women showed the following contributions to gender differences in persistent statin therapy: age 51.7%, smoking 31.5%, cardiologist evaluation 24.2%, and adverse statin reactions 6.7%. Together, these four factors contributed 89.9% to the gender disparity in persistent statin therapy.
In 24,000 patients in whom statin therapy was clearly indicated, several specific factors appear to underlie differences in statin therapy and it’s persistent use between men and women. Identifying such drivers may facilitate interventions and further research to overcome gender differences in applying proven interventions for cardiovascular risk reduction.
Author Disclosures: H. Zhang: None. J. Plutzky: None. M. Shubina: None. A. Turchin: Consultant/Advisory Board; Modest; Novo Nordisk, Monarch Medical Technologies. Research Grant; Significant; Merck.
- © 2014 by American Heart Association, Inc.