Study Shows Female Veterans with CVD Less Likely to Receive Statin and High-Intensity Statin Therapy Compared to Male Veterans with CVD
BACKGROUND:
Gender-related disparity in high-intensity statin therapy use is important to study, as the recent American College of Cardiology/American Heart Association cholesterol management guideline recommends high-intensity statin therapy in most patients with cardiovascular disease (CVD). However, gender disparities in the use of high-intensity statin therapy are not known. Therefore, this study sought to identify the proportion of male (n=959,161) and female (n=13,371) Veterans with CVD who received care in any of 130 VA facilities between 10/1/10 and 9/30/11, and who received any statin and high-intensity statin. CVD patients were those with a history of coronary heart disease, peripheral artery disease, or ischemic stroke. Using VA pharmacy data, investigators determined whether these Veterans were prescribed a statin or a high-intensity statin within 100 days prior to or 14 days following their index visit. Demographics and history of diabetes or hypertension also were assessed.
FINDINGS:
- While evidence-based use of both statin and high-intensity statin therapy remains low in both genders, female Veterans with CVD were less likely to receive evidence-based statins (58% vs. 65%) and high-intensity statins (21% vs. 24%) compared with male Veterans. In fully adjusted analyses, female gender was independently associated with a 32% lower likelihood of receiving any statin therapy and a 24% lower likelihood of receiving high-intensity statin therapy.
- Mean low-density lipoprotein cholesterol levels were higher in female compared with male Veterans (99 vs. 85 mg/dl) with CVD.
- The use of statin and high-intensity statin therapy among female Veterans with CVD showed substantial facility-level variation. The median facility-level rate of statin use among female CVD patients was 57%. For high-intensity statin therapy, the median facility-level rate was 20%.
LIMITATIONS:
- Given the observational nature of this study, residual confounding cannot be totally excluded.
- The study does not take into account trends in CVD care after 2011, or whether findings were impacted by care site (e.g., presence of gender-specific clinic).
- This study did not evaluate medication allergy or intolerance, which could partially explain the lower use of statins and high-intensity statins in women compared with men. Study results did not account for the discontinuation of statins by patients secondary to perceived or real side effects.
IMPLICATIONS:
- With the "statin dose-based approach" proposed by the recent cholesterol guidelines, these results highlight areas for quality improvement. It is important to note that despite the observed gender disparity noted in this study, statin and high-intensity statin use remain low in both genders. This is concerning as the patient population studied in these analyses (i.e., those with established CVD) are the ones who derive the most benefit from statin and high-intensity statin therapy.
Virani S, Woodard L, Ramsey D, Urech T, Akeroyd J, Shah T, Deswal A, Bozkurt B, Ballantyne C, Petersen L. Gender Disparities in Evidence-Based Statin Therapy in Patients with Cardiovascular Disease. American Journal of Cardiology. January 1, 2015;115(1):21-26.
