Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 9:18:100667.
doi: 10.1016/j.ajpc.2024.100667. eCollection 2024 Jun.

Sex-based utilization of guideline recommended statin therapy and cardiovascular disease outcomes: Data from a multisite healthcare network primary prevention cohort

Agnes Koczo  1 , Adipong Brickshawana  1 , Jianhui Zhu  1 , Floyd Thoma  1 , Malamo Countouris  1 , Kathryn Berlacher  1 , Martha Gulati  2 , Erin D Michos  3 , Steven Reis  1 , Suresh Mulukutla  1 , Anum Saeed  1
Affiliations

Sex-based utilization of guideline recommended statin therapy and cardiovascular disease outcomes: Data from a multisite healthcare network primary prevention cohort

Agnes Koczo et al. Am J Prev Cardiol. .

Abstract

Background: In the US, women have similar cardiovascular death rates as men. However, less is known about sex differences in statin use for primary prevention and associated atherosclerotic cardiovascular disease (ASCVD) outcomes.

Methods: Statin prescriptions using electronic health records were examined in patients without ASCVD (myocardial infarction (MI), revascularization or ischemic stroke) between 2013 and 2019. Guideline-directed statin intensity (GDSI) at index (at least moderate intensity, defined per pooled-cohort equation) and follow-up visits were compared between sexes across ASCVD risk groups, defined by the pooled-cohort equation. Cox regression hazard ratios were calculated for statin use and outcomes (myocardial infarction, stroke/transient ischemic attack (TIA), and all-cause mortality) stratified by sex. Interaction terms (statin and sex) were applied.

Results: Among 282,298 patients, (mean age ∼ 50 years) 17.1 % women and 19.5 % men were prescribed any statin at index visit. Time to GDSI was similar between sexes, but the proportion of high-risk women on GDSI at follow-up were lower compared to high-risk men (2-years: 27.7 vs 32.0 %, and 5-years: 47.2 vs 55.2 %, p < 0.05). When compared to GDSI, no statin use was associated with higher risk of MI and ischemic stroke/TIA among both sexes. High-risk women on GDSI had a lower risk of mortality (HR=1.39 [1.22-1.59]) vs. men (HR=1.67 [1.50-1.86]) of similar risk (p value interaction=0.004).

Conclusion: In a large contemporary healthcare system, there was underutilization of statins across both sexes in primary prevention. High-risk women were less likely to remain on GDSI compared to high-risk men. GDSI significantly improved the survival in both sexes regardless of ASCVD risk group. Future strategies to ensure continued use of GDSI, specifically among women, should be explored.

Keywords: Guideline-directed statin intensity; Primary prevention; Sex differences.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Anum Saeed reports article publishing charges was provided by UPMC. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Probability of GDSI use over follow-up period.
Unlabelled image
Central Illustration
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

References

    1. Tsao C.W., Aday A.W., Almarzooq Z.I., Alonso A., Beaton A.Z., Bittencourt M.S., Boehme A.K., Buxton A.E., Carson A.P., Commodore-Mensah Y., Elkind M.S.V., Evenson K.R., Eze-Nliam C., Ferguson J.F., Generoso G., Ho J.E., Kalani R., Khan S.S., Kissela B.M., Knutson K.L., Levine D.A., Lewis T.T., Liu J., Loop M.S., Ma J., Mussolino M.E., Navaneethan S.D., Perak A.M., Poudel R., Rezk-Hanna M., Roth G.A., Schroeder E.B., Shah S.H., Thacker E.L., Vanwagner L.B., Virani S.S., Voecks J.H., Wang N.Y., Yaffe K., Martin S.S. Heart disease and stroke statistics-2022 update: a report from the American Heart Association. Circulation. 2022;145:E153–E639. - PubMed
    1. Mann D., Reynolds K., Smith D., Muntner P. Trends in statin use and low-density lipoprotein cholesterol levels among US adults: impact of the 2001 National Cholesterol Education Program guidelines. Annal Pharmacother. 2008;42:1208–1215. - PubMed
    1. Grundy S.M., Stone N.J., Bailey A.L., Beam C., Birtcher K.K., Blumenthal R.S., Braun L.T., de Ferranti S., Faiella-Tommasino J., Forman D.E., Goldberg R., Heidenreich P.A., Hlatky M.A., Jones D.W., Lloyd-Jones D., Lopez-Pajares N., Ndumele C.E., Orringer C.E., Peralta C.A., Saseen J.J., Smith S.C., Sperling L., Virani S.S., Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:E1046–E1081. - PubMed
    1. Boekholdt S.M., Hovingh G.K., Mora S., Arsenault B.J., Amarenco P., Pedersen T.R., Larosa J.C., Waters D.D., Demicco D.A., Simes R.J., Keech A.C., Colquhoun D., Hitman G.A., Betteridge D.J., Clearfield M.B., Downs J.R., Colhoun H.M., Gotto A.M., Ridker P.M., Grundy S.M., Kastelein J.J.P. Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials. J Am Coll Cardiol. 2014;64:485–494. - PMC - PubMed
    1. Khera A.V., Everett B.M., Caulfield M.P., Hantash F.M., Wohlgemuth J., Ridker P.M., Mora S. Lipoprotein(a) concentrations, rosuvastatin therapy, and residual vascular risk: an analysis from the JUPITER trial (justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin) Circulation. 2014;129:635–642. - PMC - PubMed

LinkOut - more resources