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Observational Study
.2019 Aug;12(8):e005562.
doi: 10.1161/CIRCOUTCOMES.118.005562. Epub 2019 Aug 16.

Sex Differences in the Use of Statins in Community Practice

Affiliations
Observational Study

Sex Differences in the Use of Statins in Community Practice

Michael G Nanna et al. Circ Cardiovasc Qual Outcomes.2019 Aug.

Abstract

Background: Female patients have historically received less aggressive lipid management than male patients. Contemporary care patterns and the potential causes for these differences are unknown.

Methods and results: Examining the Patient and Provider Assessment of Lipid Management Registry-a nationwide registry of outpatients with or at risk for atherosclerotic cardiovascular disease-we compared the use of statin therapy, guideline-recommended statin dosing, and reasons for undertreatment. We specifically analyzed sex differences in statin treatment and guideline-recommended statin dosing using multivariable logistic regression. Among 5693 participants (43% women) eligible for 2013 American College of Cardiology/American Heart Association Cholesterol Guideline-recommended statin treatment, women were less likely than men to be prescribed any statin therapy (67.0% versus 78.4%; P<0.001) or to receive a statin at the guideline-recommended intensity (36.7% versus 45.2%; P<0.001). Women were more likely to report having previously never been offered statin therapy (18.6% versus 13.5%; P<0.001), declined statin therapy (3.6% versus 2.0%; P<0.001), or discontinued their statin (10.9% versus 6.1%; P<0.001). Women were also less likely than men to believe statins were safe (47.9% versus 55.2%; P<0.001) or effective (68.0% versus 73.2%; P<0.001) and more likely to report discontinuing their statin because of a side effect (7.9% versus 3.6%; P<0.001). Sex differences in both overall and guideline-recommended intensity statin use persisted after adjustment for demographics, socioeconomic factors, clinical characteristics, patient beliefs, and provider characteristics (adjusted odds ratio, 0.70; 95% CI, 0.61-0.81; P<0.001; and odds ratio, 0.82; 95% CI, 0.73-0.92; P<0.01, respectively). Sex differences were consistent across primary and secondary prevention indications for statin treatment.

Conclusions: Women eligible for statin therapy were less likely than men to be treated with any statin or guideline-recommended statin intensity. A combination of women being offered statin therapy less frequently, while declining and discontinuing treatment more frequently, accounted for these sex differences in statin use.

Keywords: primary prevention; secondary prevention; sex; sex characteristics; women.

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Figures

Figure 1.
Figure 1.. Statin Utilization in Female vs. Male Patients
This figure displays statin utilization in male and female patientsaccording to percentages on a statin, never offered a statin, declined a statin,and discontinued a statin.
Figure 2.
Figure 2.. Multivariable Modelling Results for Statin Utilization in Female vs. Male Patients
Based on results of a logistic regression model that included age, race,prior ASCVD grouped into CAD, CVD and PAD, diabetes, obesity, smoking,hypertension, heart failure, yearly income, insurance status, education level,patient numeracy, patient beliefs including worry about heart disease, physiciantrust, statin beliefs about safety, effectiveness and the link between highcholesterol and heart attack risk, cardiologist vs. non-cardiologist, use of2013 ACC/AHA guideline, urban vs. rural setting, and provider time in practice.In subgroup analyses, the variable that defined the subgroup was not adjustedfor except in the secondary prevention group where type of ASCVD was included inthe model (CAD vs. CVD vs. PAD). ACC = American College of Cardiology; AHA = American Heart Association;ASCVD, atherosclerotic cardiovascular disease; CAD = coronary artery disease;CVD = cerebrovascular disease; CI = confidence interval; GR =guideline-recommended; PAD = peripheral vascular disease
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