In the JournalsPerspective

High-intensity statin therapy less likely in women after MI

Sanne A.E. Peters

Women were less likely to fill a prescription for high-intensity statins after hospitalization for MI compared with men, according to a study published in the Journal of the American College of Cardiology.

“While the use of high-intensity statins increased in both sexes who filled any statin prescription following MI between 2007 and 2015, our study shows that women continue to be less likely than men to fill a prescription for high-intensity statins,” Sanne A.E. Peters, PhD, research fellow in epidemiology at The George Institute for Global Health at University of Oxford in the United Kingdom, told Cardiology Today. “The underutilization of high-intensity statins in women can be expected to result in a substantial additional number of preventable vascular events.”

Patients with MI hospitalizations

In this retrospective cohort study, researchers reviewed data from 16,898 patients (26% women) younger than 65 years with commercial health insurance and 71,358 patients (49% women) aged at least 66 years with Medicare. Both groups of patients had an overnight hospitalization for MI between 2014 and June 2015. Medicare beneficiaries were alive 30 days after hospital discharge and had continuous insurance coverage during the study.

This study included statin fills of any dosage within 30 days of hospital discharge for MI. High-intensity statins of interest were 40 mg or 80 mg of atorvastatin and 20 mg or 40 mg of rosuvastatin.

Men were more likely to fill a prescription for high-intensity statin after hospital discharged compared with women (56% vs. 47%).

After adjusting for comorbidities, demographic characteristics and health care use, the women-to-men RRs for high-intensity statins were the following:

  • 0.91 for the total population using statins (95% CI, 0.9-0.92);
  • 0.91 in those who did not previously use statins (95% CI, 0.89-0.92);
  • 0.87 for those with prior low- or moderate-intensity statin use (95% CI, 0.85-0.9); and
  • 0.98 in those who previously took high-intensity statins (95% CI, 0.97-1).

Sex disparities in statins

Compared with men, women were less likely to fill prescriptions for high-intensity statins in all subgroups. This disparity was most evident in patients without prevalent comorbid conditions and in the youngest and oldest adults.

“Clinicians should communicate the benefits of high-intensity statins to their female patients in terms of reducing the risk of recurrent MI and discuss possible concerns about side effects,” Peters said in an interview. “Moreover, clinicians themselves should also be aware of the risk of recurrent MI in their female patients and the persistent sex disparity in the utilization of high-intensity statins. Although the ‘Go Red for Women’ initiative and evidence-based guidelines for the prevention of CVD in women may have contributed to the decline in CVD rates in women, the results from the current study suggest that they have not led to elimination of the sex differences in high-intensity statin use after MI among individuals who filled any statin prescription. Further efforts are needed to eliminate sex disparities in high-intensity statin use and to improve the use of high-intensity statin therapy following hospital discharge for MI for all patients.”

In a related editorial, Annabelle Santos Volgman, MD, FACC, FAHA, professor of medicine at Rush Medical College in Chicago, senior attending physician at Rush University Medical Center and medical director of the Rush Heart Center for Women, and colleagues wrote: “We think sex should matter, as well as age, race and ethnicities, when it comes to patient care and adherence to guidelines. Implementation of such sex-specific strategies will improve CVD outcomes for women and, by doing so, may also improve outcomes for men.” – by Darlene Dobkowski

For more information:

Sanne A.E. Peters, PhD, can be reached at sanne.peters@georgeinstitute.ox.ac.uk.

Disclosures: This study was funded by a collaboration between Amgen and University of Alabama at Birmingham. Peters and the editorial authors report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

Sanne A.E. Peters

Women were less likely to fill a prescription for high-intensity statins after hospitalization for MI compared with men, according to a study published in the Journal of the American College of Cardiology.

“While the use of high-intensity statins increased in both sexes who filled any statin prescription following MI between 2007 and 2015, our study shows that women continue to be less likely than men to fill a prescription for high-intensity statins,” Sanne A.E. Peters, PhD, research fellow in epidemiology at The George Institute for Global Health at University of Oxford in the United Kingdom, told Cardiology Today. “The underutilization of high-intensity statins in women can be expected to result in a substantial additional number of preventable vascular events.”

Patients with MI hospitalizations

In this retrospective cohort study, researchers reviewed data from 16,898 patients (26% women) younger than 65 years with commercial health insurance and 71,358 patients (49% women) aged at least 66 years with Medicare. Both groups of patients had an overnight hospitalization for MI between 2014 and June 2015. Medicare beneficiaries were alive 30 days after hospital discharge and had continuous insurance coverage during the study.

This study included statin fills of any dosage within 30 days of hospital discharge for MI. High-intensity statins of interest were 40 mg or 80 mg of atorvastatin and 20 mg or 40 mg of rosuvastatin.

Men were more likely to fill a prescription for high-intensity statin after hospital discharged compared with women (56% vs. 47%).

After adjusting for comorbidities, demographic characteristics and health care use, the women-to-men RRs for high-intensity statins were the following:

  • 0.91 for the total population using statins (95% CI, 0.9-0.92);
  • 0.91 in those who did not previously use statins (95% CI, 0.89-0.92);
  • 0.87 for those with prior low- or moderate-intensity statin use (95% CI, 0.85-0.9); and
  • 0.98 in those who previously took high-intensity statins (95% CI, 0.97-1).

Sex disparities in statins

Compared with men, women were less likely to fill prescriptions for high-intensity statins in all subgroups. This disparity was most evident in patients without prevalent comorbid conditions and in the youngest and oldest adults.

“Clinicians should communicate the benefits of high-intensity statins to their female patients in terms of reducing the risk of recurrent MI and discuss possible concerns about side effects,” Peters said in an interview. “Moreover, clinicians themselves should also be aware of the risk of recurrent MI in their female patients and the persistent sex disparity in the utilization of high-intensity statins. Although the ‘Go Red for Women’ initiative and evidence-based guidelines for the prevention of CVD in women may have contributed to the decline in CVD rates in women, the results from the current study suggest that they have not led to elimination of the sex differences in high-intensity statin use after MI among individuals who filled any statin prescription. Further efforts are needed to eliminate sex disparities in high-intensity statin use and to improve the use of high-intensity statin therapy following hospital discharge for MI for all patients.”

In a related editorial, Annabelle Santos Volgman, MD, FACC, FAHA, professor of medicine at Rush Medical College in Chicago, senior attending physician at Rush University Medical Center and medical director of the Rush Heart Center for Women, and colleagues wrote: “We think sex should matter, as well as age, race and ethnicities, when it comes to patient care and adherence to guidelines. Implementation of such sex-specific strategies will improve CVD outcomes for women and, by doing so, may also improve outcomes for men.” – by Darlene Dobkowski

For more information:

Sanne A.E. Peters, PhD, can be reached at sanne.peters@georgeinstitute.ox.ac.uk.

Disclosures: This study was funded by a collaboration between Amgen and University of Alabama at Birmingham. Peters and the editorial authors report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

    Perspective
    C. Noel Bairey Merz, MD, FACC, FAHA

    C. Noel Bairey Merz

    These findings demonstrate a persistent gender gap of lower/lessor treatment of evidence-based lifesaving medical treatment that are standard guidelines in women with CVD.

    Lower and lessor statin treatment in women results in unnecessary loss of female lives.

    We need practical clinical trials testing strategies to eliminate this important gender gap. Carnes and colleagues conducted a randomized controlled trial (Carnes M, et al. Acad Med. 2015;doi:10.1097/ACM.0000000000000552) of a successful strategy that reduced gender gaps in meritorious academic promotions in disadvantaged women. Successful strategies would then be widely disseminated, similar to other lifesaving policies such as flu shots, STEMI networks, etc.

    We should look at all CVD and non-CVD therapies with this lens. There are likely untold number of female lives being lost widespread in health care.

    • C. Noel Bairey Merz, MD, FACC, FAHA, FESC
    • Cardiology Today Editorial Board Member
      Cedars-Sinai Medical Center

    Disclosures: Bairey Merz reports no relevant financial disclosures.

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