Gender Bias in Rates of Statin Therapy in Women
Editor's Note: Commentary based on Victor BM, Teal V, Ahedor L, Karalis DG. Gender Differences in Achieving Optimal Lipid Goals in Patients With Coronary Artery Disease. Am J Cardiol 2014. [Epub ahead of print].
Recent ACC/AHA Guidelines have emphasized the importance of high potency statins in all patients with CAD irrespective of patient sex, race or ethnicity. However, sex-based disparities are well known. In this article, investigators assess whether sex difference existed in lipid goal attainment in a large community practice in Philadelphia.
In order to investigate differences in lipid goal attainment, the investigators conducted a retrospective analysis of outpatient electronic health records from a large cardiology practice, Cardiology Consultants of Philadelphia from September 2008 to September 2009. In total, 23, 408 patients with a history of CAD were identified. Of these, a total of 9,950 (34% women) had full lipid panels. The most recent lipid profile and lipid-lowering medications and doses were obtained from the electronic medical record.
In this study, compared with men, women were less likely to achieve a low-density lipoprotein (LDL) cholesterol goal of <70 mg/dl compared (30.6% vs 38.4%, p <0.001) and less likely to achieve a non-high-density lipoprotein cholesterol goal of <100 mg/dl (37.1% vs 48.2%, p <0.001). Women were less likely to achieve their LDL cholesterol goals even after controlling for age. Compared with men, women were more likely to be on no statin (16.9% vs 11.6%, p <0.001) or any lipid-lowering therapy (12.8% vs 7.8%, p <0.001) and less likely to be on high-potency statin (14.9% vs 18.0%, p<0.001) or combination therapy (22.2% vs 30.1%, p <0.001).
Based on data from a large subspecialty cardiology practice, there continues to exists a major difference in the use of appropriate lipid-lowering therapy
These data are consistent with a large body of evidence that demonstrates that women are less likely to receive evidence based therapies in general and lipid lowering specifically, even when ideal candidates and irrespective of age. Further studies are required to determine what barriers may exist to the use of evidence-based therapies in women. For now, clinicians should be reminded that the current ACC/AHA guidelines for the management of lipids in CAD patients recommends high potency, high dose statins irrespective of patient sex based on large scale randomized trials. Given that data are robust and without question in this area, it is hoped that rates of statin use in women with CAD will improve.
Keywords: Coronary Artery Disease, Ethnic Groups, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipids, Sex Characteristics
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