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Sex-Related Health Care Disparities Among Premature ASCVD Patients
Quick Takes
- Compared with men, young women with premature ASCVD (age ≤55 years) and extremely premature ASCVD (age ≤40 years) were less likely to receive antiplatelet agents, any statin, or high-intensity statin therapy.
- Both men and women with premature ASCVD received suboptimal aspirin and statin therapy and had poor statin adherence.
Study Questions:
Among veterans with premature atherosclerotic cardiovascular disease (ASCVD), what are the sex-based differences in secondary prevention in terms of treatment with antiplatelet agents, any statin, high-intensity statin, and statin adherence?
Methods:
The VITAL (Veterans With Premature Atherosclerosis) registry is a nationwide VA health care system study of 147,600 patients with at least one primary care visit in 2014-2015 and a diagnosis of premature ASCVD (including ischemic heart disease, cerebrovascular disease, and peripheral arterial disease). The outcomes were antiplatelet use, any statin use, high-intensity statin use, and statin adherence.
Results:
Of 147,600 veterans with premature ASCVD (age ≤55 years), 7.1% were women; 9,485 had extremely premature ASCVD (age ≤40 years) and 14.1% were women. In comparison with men, women with premature ASCVD had a higher proportion of African American patients (36% vs. 24%). Among patients with premature ischemic heart disease, women received less antiplatelet (adjusted odds ratio [AOR], 0.47; 95% confidence interval [CI], 0.45-0.50), statin (AOR, 0.62; 95% CI, 0.59-0.66), or high-intensity statin therapy (AOR, 0.63; 95% CI, 0.59-0.66) and were less statin-adherent compared with men. Women with extremely premature ASCVD also received less treatment compared with men: antiplatelet (AOR, 0.61; 95% CI, 0.53-0.70), any statin (AOR, 0.51; 95% CI, 0.44-0.58), and high-intensity statin therapy (AOR, 0.45; 95% CI, 0.37-0.54). Statin adherence was similar in men and women with premature ischemic cerebrovascular disease and peripheral arterial disease, or extremely premature ASCVD.
Conclusions:
The authors concluded that women veterans with premature ASCVD and extremely premature ASCVD were less likely to receive optimal secondary prevention CV care in comparison with men.
Perspective:
This study showed that young women veterans with premature ASCVD were significantly less likely to receive antiplatelet treatment, any statin, or high-intensity statin therapy compared with men. Prior studies have demonstrated worse mortality for young women with premature coronary artery disease; this study demonstrates inadequate medical therapy for this high-risk group, which may contribute to worse outcomes. Potential reasons for the undertreatment of young women include under-recognition of ASCVD, concern for safety of statins in women of child-bearing age, and lack of clinician and patient awareness of risk and the importance of secondary prevention of ASCVD. Future research is needed to address the treatment disparities identified in this national study of young people with premature ASCVD.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Nonstatins, Novel Agents, Statins
Keywords: Atherosclerosis, Cerebrovascular Disorders, Coronary Artery Disease, Dyslipidemias, Healthcare Disparities, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Ischemia, Peripheral Arterial Disease, Platelet Aggregation Inhibitors, Primary Health Care, Secondary Care, Secondary Prevention, Vascular Diseases, Veterans, Women, Young Adult
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