Preventive Cardiology
Gender Disparities in Evidence-Based Statin Therapy in Patients With Cardiovascular Disease

https://doi.org/10.1016/j.amjcard.2014.09.041Get rights and content

Studies have shown gender disparities in cholesterol care in patients with cardiovascular disease (CVD), with women less likely than men to have low-density lipoprotein cholesterol levels <100 mg/dl. Whether this is related to a lower evidence-based statin or high-intensity statin use is not known. We used a national cohort of 972,532 patients with CVD (coronary heart disease, peripheral artery disease, and ischemic stroke) receiving care in 130 Veterans Health Administration facilities from October 1, 2010, to September 30, 2011, to identify the proportion of male and female patients with CVD receiving any statin and high-intensity statin. Women with CVD (n = 13,371) were less likely than men to receive statins (57.6% vs 64.8%, p <0.0001) or high-intensity statins (21.1% vs 23.6%, p <0.0001). Mean low-density lipoprotein cholesterol levels (99 vs 85 mg/dl) were higher in women compared with men (p <0.0001). In adjusted models, female gender was independently associated with a lower likelihood of receiving statins (odds ratio 0.68, 95% confidence interval 0.66 to 0.71) or high-intensity statins (odds ratio 0.76, 95% confidence interval 0.73 to 0.80). The median facility-level rate of statin and high-intensity statin use among female patients (57.3% [interquartile range = 8.93%] for statin, 20% [interquartile range = 7.7%] for high-intensity statin use) showed significant variation. In conclusion, women with CVD are less likely to receive evidence-based statin and high-intensity statins compared with men, although, their use remains low in both genders. There is a significant facility-level variation in evidence-based statin or high-intensity statin use in female patients with CVD. With the “statin dose-based approach” proposed by the recent cholesterol guidelines, these results highlight areas for quality improvement.

Section snippets

Methods

Using the Department of Veterans Affairs (VA) administrative data sources, we identified patients with CVD with primary care clinic visits in the VA health care system (130 facilities or their associated community-based outpatient clinics) from October 1, 2010, to September 30, 2011. Patients with CVD were those with a history of coronary heart disease or peripheral artery disease, including ischemic stroke. We identified patients as having coronary heart disease using International

Results

We excluded 10,941 (1.1%) patients with documented metastatic care or terminal illness from our initial cohort of 983,476 patients (Figure 1). Our final analyses included 972,532 patients with 13,371 women (1.4%) and 959,161 (98.6%) men. Table 1 lists a comparison of the baseline characteristics between female and male patients with CVD. Female patients with CVD were on average younger, less often White, had a lower prevalence of diabetes and hypertension, and a higher prevalence of peripheral

Discussion

In these analyses from a national cohort of patients with CVD in the VA health care system, we found that female patients were less likely than male patients to receive statin and high-intensity statins. We also found that there was substantial facility-level variation in both statin and especially, high-intensity statin use among female patients. Finally, although gender disparities in statin or high-intensity statin receipt were seen, both genders had a low proportion of patients receiving

Acknowledgment

The authors thank Mark Kuebeler, MS, for his programming effort on this manuscript.

References (20)

There are more references available in the full text version of this article.

Cited by (130)

View all citing articles on Scopus

This work was also supported by the Houston Veterans Affairs Health Services Research and Development Center for Innovations grant (grant HFP 90-020). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

See page 25 for disclosure information.

View full text