Sex Differences in the Use of Statins in Community Practice

Michael G. Nanna, Tracy Y. Wang, Qun Xiang, Anne C. Goldberg, Jennifer G. Robinson, Veronique Lee Roger, Salim S. Virani, Peter W.F. Wilson, Michael J. Louie, Andrew Koren, Zhuokai Li, Eric D. Peterson, Ann Marie Navar

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)e005562
JournalCirculation. Cardiovascular quality and outcomes
Volume12
Issue number8
DOIs
StatePublished - Aug 1 2019

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Sex Characteristics
Guidelines
Therapeutics
Registries
Odds Ratio
Lipids

Keywords

  • primary prevention
  • secondary prevention
  • sex
  • sex characteristics
  • women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Nanna, M. G., Wang, T. Y., Xiang, Q., Goldberg, A. C., Robinson, J. G., Roger, V. L., ... Navar, A. M. (2019). Sex Differences in the Use of Statins in Community Practice. Circulation. Cardiovascular quality and outcomes, 12(8), e005562. https://doi.org/10.1161/CIRCOUTCOMES.118.005562

Sex Differences in the Use of Statins in Community Practice. / Nanna, Michael G.; Wang, Tracy Y.; Xiang, Qun; Goldberg, Anne C.; Robinson, Jennifer G.; Roger, Veronique Lee; Virani, Salim S.; Wilson, Peter W.F.; Louie, Michael J.; Koren, Andrew; Li, Zhuokai; Peterson, Eric D.; Navar, Ann Marie.

In: Circulation. Cardiovascular quality and outcomes, Vol. 12, No. 8, 01.08.2019, p. e005562.

Research output: Contribution to journalArticle

Nanna, MG, Wang, TY, Xiang, Q, Goldberg, AC, Robinson, JG, Roger, VL, Virani, SS, Wilson, PWF, Louie, MJ, Koren, A, Li, Z, Peterson, ED & Navar, AM 2019, 'Sex Differences in the Use of Statins in Community Practice', Circulation. Cardiovascular quality and outcomes, vol. 12, no. 8, pp. e005562. https://doi.org/10.1161/CIRCOUTCOMES.118.005562
Nanna, Michael G. ; Wang, Tracy Y. ; Xiang, Qun ; Goldberg, Anne C. ; Robinson, Jennifer G. ; Roger, Veronique Lee ; Virani, Salim S. ; Wilson, Peter W.F. ; Louie, Michael J. ; Koren, Andrew ; Li, Zhuokai ; Peterson, Eric D. ; Navar, Ann Marie. / Sex Differences in the Use of Statins in Community Practice. In: Circulation. Cardiovascular quality and outcomes. 2019 ; Vol. 12, No. 8. pp. e005562.
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AU - Xiang, Qun

AU - Goldberg, Anne C.

AU - Robinson, Jennifer G.

AU - Roger, Veronique Lee

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

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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.

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