TY - JOUR
T1 - Sex Differences in the Use of Statins in Community Practice
T2 - Patient and Provider Assessment of Lipid Management Registry
AU - Nanna, Michael G.
AU - Wang, Tracy Y.
AU - Xiang, Qun
AU - Goldberg, Anne C.
AU - Robinson, Jennifer G.
AU - Roger, Veronique L.
AU - Virani, Salim S.
AU - Wilson, Peter W.F.
AU - Louie, Michael J.
AU - Koren, Andrew
AU - Li, Zhuokai
AU - Peterson, Eric D.
AU - Navar, Ann Marie
N1 - Funding Information:
This study was supported by Sanofi Pharmaceuticals and Regeneron Pharmaceuticals. Dr Navar is also funded by National Institutes of Health (NIH) K01HL133416-01. Dr Nanna is also supported by NIH training grant T-32-HL069749-15.
Funding Information:
Dr Wang reports research grants (modest) from Amgen, Bristol-Myers Squibb, Cryolife, Novartis, Pfizer, and Portola; research grants (significant) from Astra-Zeneca and Regeneron Pharmaceuticals; and honoraria (modest) from Gri-fols and Gilead. Dr Goldberg reports research grants (modest) from Amarin, Amgen, and Pfizer; research grants (significant) from Regeneron, Regeneron/ Sanofi, and IONIS; honoraria (modest) from Merck Manual; and belongs to the consultant/advisory board (modest) at Regeneron/Sanofi, Esperion, Novartis, and AKCEA. Dr Robinson reports research grants (significant) from Acasti, Amarin, Amgen, AstraZeneca, Esai, Merck, Novartis, Pfizer, Regeneron/Sanofi, and Takeda; belongs to the consultant/advisory board (modest) at Amgen, Merck, Novartis, Novo Nordisk, and Pfizer; and consultant/advisory board (significant) Sanofi and Regeneron. Dr Virani reports research grant (significant) from American Heart Association, American Diabetes Association, and Veteran’s Affairs and honoraria (significant) from the American College of Cardiology (Associate Editor for Innovations, acc.org). Dr Louie reports employment (significant) at Regeneron and ownership interest (modest) at Regeneron. Dr Koren reports employment (significant) at Sanofi. Dr Peterson reports research grants (significant) from Amgen, Sanofi, AstraZeneca, and Merck; belongs to the consultant/ advisory board (modest) at Amgen; and consultant/advisory board (significant) at AstraZeneca, Merck, and Sanofi Aventis. Dr Navar reports research grants (significant) from Amarin, Janssen, Amgen, Sanofi, and Regeneron Pharmaceuticals and belongs to the consultant/advisory board (significant) at Amarin, Amgen, Novo Nordisk, AstraZeneca, Sanofi, and Regeneron. The other authors report no conflicts.
Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - 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.
AB - 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.
KW - primary prevention
KW - secondary prevention
KW - sex
KW - sex characteristics
KW - women
UR - http://www.scopus.com/inward/record.url?scp=85071544906&partnerID=8YFLogxK
U2 - 10.1161/CIRCOUTCOMES.118.005562
DO - 10.1161/CIRCOUTCOMES.118.005562
M3 - Article
C2 - 31416347
AN - SCOPUS:85071544906
SN - 1941-7713
VL - 12
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 8
M1 - e005562
ER -