Women Less Likely to Take Statins After MI

Study Questions:

Are women less likely to receive high-intensity statin therapy after a myocardial infarction (MI)?

Methods:

Data from the MarketScan database and Medicare were used to examine statin use following MIs among men and women. MarketScan includes commercial health insurance plans. Adults were identified by MI hospital admission date and were excluded if they were discharged to an acute care or skilled nursing facility or hospice within 30 days of discharge. Only adults with continuous insurance coverage (which included pharmacy benefits) were included in the present analysis. To examine trends in sex differences in high-intensity statin use over time, a second study population that included beneficiaries with an MI hospitalization between January 1, 2007, and June 30, 2015, who met the inclusion criteria was compared to the later cohort. Risk ratios comparing women to men were calculated for filling a high-intensity statin prescription such as 40-80 mg of atorvastatin or 20-40 mg of rosuvastatin.

Results:

A total of 16,898 US adults (26% women) aged <65 years and 71,358 US adults (49% women) ≥66 years and who filled statin prescriptions within 30 days of hospital discharge for an MI between 2014 and 2015 were included in the study. From 2014 to 2015, 56% of men and 47% of women filled a high-intensity statin following hospital discharge for MI. Adjusted risk ratios for filling a high-intensity statin comparing women with men were 0.91 (95% confidence interval [CI], 0.90-0.92) in the total population, 0.91 (95% CI, 0.89-0.92) among those with no prior statin use, and 0.87 (95% CI, 0.85-0.90) and 0.98 (95% CI, 0.97-1.00) for those taking low-/moderate-intensity and high-intensity statins prior to their MI, respectively. Women were less likely than men to fill high-intensity statins within all subgroups analyzed, and the disparity was largest in the youngest and oldest adults and for those without prevalent comorbid conditions. Between 2007 and 2015, the percentage of beneficiaries whose first statin prescription fill following hospital discharge after MI was for a high-intensity statin increased from 27% to 60% in men and from 22% to 50% in women.

Conclusions:

The authors concluded that despite recent efforts to reduce sex differences in guideline-recommended therapy, women continue to be less likely than men to fill a prescription for high-intensity statins following hospitalization for MI.

Perspective:

These data suggest that although the rate of statin use among women has increased, use of statin remains lower than in men after an MI. Understanding the factors associated with this difference has important implications for care. Whether the difference is in prescribing practices or at the patient level needs to be understood.

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Geriatric Cardiology, Prevention, Nonstatins, Novel Agents, Statins

Keywords: Acute Coronary Syndrome, Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Insurance Coverage, Insurance, Health, Medicare, Myocardial Infarction, Primary Prevention, Sex Characteristics, Women


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