Why Do Women in the USA Receive Indicated Statin Therapy Less and in Lower Doses Than Men?

Study Methodology and Population

A total of 5,693 individuals (43% women; mean age 68 years) from the national PALM registry (The Patient and Provider Assessment of Lipid Management), which includes outpatient patients with ASCVD (atherosclerotic cardiovascular disease) or at high risk for ASCVD, were included in the study.

ASCVD is defined as:

1. coronary artery disease (past myocardial infarction, coronary artery disease, history of percutaneous coronary intervention, coronary bypass…)
2. peripheral artery disease (history of abdominal aortic aneurysm, carotid stenosis, arterial revascularization…)
3. cerebrovascular disease (stroke, transient ischemic attack) in history

A total of 5,693 individuals (57% men; mean age 68 years) who met the indication for statin therapy were included in the study. It was also assessed whether a so-called high-intensity lipid-lowering therapy was indicated and possibly administered. This is (according to the then-current 2013 ACC/AHA guidelines) recommended for all patients who meet at least one of the following criteria:

• ASCVD in history and age ≤ 75 years
• LDL-c ≥ 190 mg/dl (= 4.9 mmol/l)
• age 40-75 years + DM and calculated 10-year ASCVD risk ≥ 7.5% (with LDL-c ≥ 70 mg/dl = 1.8 mmol/l in patients without statin therapy; regardless of LDL-c concentration in patients already on statins)

Through questioning and determining lipid spectrum parameters, the necessary data regarding patients' subjective attitudes and objective clinical data were obtained. Compared to men, women in the monitored group were more often of dark skin, had a higher BMI, lower 10-year ASCVD risk, higher serum lipid concentrations, more frequently had ASCVD in their history, and were less dependent on nicotine.

Results

The study results showed that women in the USA take indicated statins less frequently than men (67.0 vs. 78.4%; p < 0.001). Similarly, a lower proportion of women compared to men take the recommended statin dose according to the guidelines (36.7 vs. 45.2%; p < 0.001). Women more often reported that statin therapy was never recommended to them (18.6 vs. 13.5%; p < 0.001), but also that they refused (3.6 vs. 2.0%; p < 0.001) or discontinued it for some reason (10.9 vs. 6.1%; p < 0.001).

More women than men stated they discontinued statin use specifically due to adverse side effects (7.9 vs. 3.6%; p < 0.001). Women also more often mentioned that they do not trust the safety of statin therapy (47.9 vs. 55.2% believed in safety; p < 0.001) or its effectiveness (68.0 vs. 73.2% believed in effectiveness; p < 0.001). Women included in the study were less often under the outpatient care of a cardiologist compared to men (51.9 vs. 65.2%; p < 0.001).

Differences in the frequency of statin use between men and women remained significant even after considering demographic and socioeconomic factors, clinical characteristics, patients' beliefs, and healthcare providers' characteristics. Comparable disparities were observed in the (non)use of statins for both primary and secondary prevention. The gender difference was not noted only among patients with LDL-c ≥ 190 mg/dl (4.9 mmol/l).

Discussion and Conclusion

The reasons why women receive indicated statin therapy less frequently and in lower doses than men may be multiple. The most significant appears to be the fact that this therapy is less often offered to women. However, significant deficiencies in statin use are found in both genders. This is contributed to by both doctors who do not recommend statin therapy to all indicated patients and patients who refuse or discontinue this treatment. Optimizing requires education regarding the safety and efficacy of statins, for both patients and doctors.

(mafi)

Source: Nanna M. G., Tracy Y. W., Xiang Q. et al. Sex differences in the use of statins in community practice. Circ Cardiovasc Qual Outcomes 2019; 12: e005562, doi: 10.1161/CIRCOUTCOMES.118.005562.