Less than half of women who filled a statin prescription following myocardial infarction (MI) received a high-intensity statin ─ and women are less likely than men to be prescribed this treatment, according to a study published April 16 in the Journal of the American College of Cardiology. The persistent gap in cardiovascular disease treatment between women and men continues despite similar effectiveness of more-intensive statins for both sexes and recent efforts to reduce sex differences in guideline-recommended treatment.

Using the MarketScan and Medicare databases, Sanne A.E. Peters, PhD, et al., analyzed data from 88,256 U.S. adults who filled a statin prescription within 30 days after hospital discharge for MI between January 2014 and June 2015. High-intensity doses were the first statin prescription fill following hospital discharge after MI for 47 percent of women and 56 percent of men. Trends in sex differences in high-intensity statin use over time were examined using beneficiaries with the same inclusion criteria between January 2007 and June 2015.

Overall, high-intensity statin prescription fills increased from 22 percent to 50 percent in women and from 27 percent to 60 percent in men. The difference in the use of high-intensity statins after MI between sexes was larger among the youngest and oldest patients and among those without comorbidities. Women were consistently less intensively treated across a broad range of patient characteristics.

Researchers found no evidence of the sex difference in the use of high-intensity statins post MI diminishing between 2007 and 2015 or following the publication of the 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, which recommends the use of high-intensity statin therapy for women and men less than 75 years of age with established heart disease for secondary prevention. The researchers said clinicians may perceive women who have experienced MI to be at a lower risk of recurrence than their male counterparts.

In an accompanying editorial, Annabelle Santos Volgman, MD, FACC, et al., state the importance of determining the barriers facing both women and men in receiving guideline-recommended care. They also note pathophysiologic differences in the disease presentation in women and men may contribute to clinicians treating women less aggressively. “We think sex should matter, as well as age, race and ethnicities when it comes to patient care and adherence to guidelines,” they explain. “Implementation of such sex-specific strategies will improve cardiovascular disease outcomes for women and by doing so may also improve outcomes for men.”

Keywords: Female, American Heart Association, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Secondary Prevention, Sex Characteristics, Cardiovascular Diseases, Risk Factors, Myocardial Infarction, Medicare, Comorbidity, Patient Care, Cholesterol

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