Unlike their male counterparts, women veterans with premature atherosclerotic cardiovascular disease (ASCVD) receive "less optimal" secondary prevention cardiovascular care, according to a study published April 21 in JAMA Cardiology. Comprehensive interventions are crucial towards improving this health care disparity in women.

Michelle T. Lee, MD, et al., looked at 147,600 veteran patients enrolled in the Veterans With Premature Atherosclerosis registry and examined sex-based differences in cardiovascular care for patients with premature or extremely premature ASCVD between Oct. 1, 2014, and Sept. 30, 2015. The primary outcome was antiplatelet use, any statin and high-intensity statin therapy, and statin adherence.

Results showed that women veterans represented 7.1% of the patients with premature ASCVD and 14.1% of the patients with extremely premature ASCVD. Women with premature ischemic heart disease were less statin adherent than men, yet less likely to receive antiplatelet agents, statins, and high-intensity statin therapy. Similarly, female participants with premature peripheral arterial disease (PAD) and ischemic cerebrovascular disease received significantly fewer antiplatelet agents, statin therapy, and high-intensity statin therapy than male patients. Researchers found no distinctions in statin adherence between male and female patients with premature PAD, premature ischemic cerebrovascular disease, or extremely premature ASCVD.

Although the authors found that women patients with premature or extremely premature ASCVD received notably fewer antiplatelets, statin therapy, or high-intensity statin therapy than men, they also found that both sexes received inadequate statin therapy and maintained poor statin adherence overall.

The authors conclude that moving forward, "A systems-based approach toward improvement of sex-based health care delivery necessitates prompt efforts to narrow sex-based health care delivery gap for women." They add that, "After identifying gaps in current health care, addressing those issues will require implementing system-level interventions to improve guideline-concordant practices among clinicians and medication adherence among patients."

Clinical Topics: Dyslipidemia, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins

Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Veterans, Platelet Aggregation Inhibitors, Secondary Prevention, Peripheral Arterial Disease, Healthcare Disparities, Atherosclerosis, Coronary Artery Disease, Medication Adherence, Cerebrovascular Disorders

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