Women remain less likely to receive high-intensity statins following heart attack

April 16, 2018, American College of Cardiology

Less than half of women who filled a statin prescription following a heart attack received a high-intensity statin—indicating they continue to be less likely than men to be prescribed this lifesaving treatment, according to a study published today in the Journal of the American College of Cardiology. The persistent gap in heart disease treatment between women and men continues despite similar effectiveness of more-intensive statins for both sexes and recent efforts to reduce sex difference in guideline-recommended treatment.

The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends the use of high-intensity therapy for women and men less than 75 years of age with established for secondary prevention.

"Prior studies have found that women are less likely than men to receive treatment with statins following a attack. Our study shows that even when women receive statins, these continue to be in lower intensities than the guidelines recommend. The underutilization of these drugs in women was not explained by in demographics, comorbidities or health care utilization," said Sanne A.E. Peters, PhD, a research fellow in epidemiology at the George Institute for Global Health at the University of Oxford and the lead author of the study.

Using the MarketScan and Medicare databases, researchers analyzed data from 88,256 U.S. adults who filled a statin prescription within 30 days after hospital discharge for a heart attack between January 2014 and June 2015. High-intensity doses were the first statin prescription fill following hospital discharge after heart attack 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.

Researchers found no evidence of the sex difference in the use of high-intensity statins post heart attack diminishing between 2007 and 2015 or following the publication of the 2013 ACC/AHA cholesterol guideline.

"While we found that the magnitude of the sex difference in the use of high-intensity statins after heart attack 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," Peters said. "This gap between our youngest and oldest patients is concerning because the oldest are at the highest risk and young women have been shown to have the slowest rate of decline in heart disease rates in the United States. The underutilization of high-intensity statins in women can be expected to result in a substantial number of preventable vascular events."

The researchers said clinicians may perceive women who have experienced a heart attack to be at a lower risk of recurrence than their male counterparts. A previous study found that sex disparities in treatment were in part due to clinicians' lower perceived heart disease risk in women. The sex difference in the use of high-intensity statins may be explained by variation at the hospital or health care provider level.

"Clinicians should communicate the benefits of high-intensity statins to their female patients in terms of reducing the risk of another heart attack and discuss possible concerns about side effects," Peters said. "Moreover, clinicians themselves should also be aware of the risk of recurrent in their female patients and the persistent sex disparity in the utilization of high-intensity statins."

In an accompanying editorial, Annabelle Santos Volgman, MD, FACC, and colleagues at Rush Medical College, stated the importance of determining the barriers facing both women and men in receiving guideline-recommended care. They also noted pathophysiologic differences in the disease presentation in women and men may contribute to clinicians treating women less aggressively. Women are more likely to present with nonobstructive disease, which is not benign, but patients and doctors minimize the significance of nonobstructive coronary artery disease leaving patients undertreated with lower intensity statins.

They said, "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 and by doing so may also improve outcomes for men."

Limitations of the study include that pharmacy claims identified whether a prescription was filled and do not provide information about the actual written prescription, medication adherence or the reason a clinician may have prescribed a lower-intensity statin.

Explore further: Adherence to high-intensity statin drops-off for many following heart attack

More information: Journal of the American College of Cardiology (2018). DOI: 10.1016/j.jacc.2018.02.032

Related Stories

Adherence to high-intensity statin drops-off for many following heart attack

April 19, 2017
A substantial proportion of patients prescribed high-intensity statins following hospitalization for a heart attack did not continue taking this medication with high adherence at two years after discharge, according to a ...

Heart attack and stroke patients prescribed statin medication upon discharge have better outcomes

November 12, 2017
Patients with a prior history of heart attacks or stroke have better outcomes when cholesterol-lowering medications are used after they're discharged from the hospital, according to a new study from the Intermountain Medical ...

Few patients fill high-intensity statin Rx after CHD discharge

January 20, 2015
(HealthDay)—Only about a quarter of Medicare beneficiaries fill a high-intensity statin prescription after discharge from hospitalization for a coronary heart disease (CHD) event, according to a study published in the Jan. ...

New study shows HIV-infected women not using statins as recommended

December 7, 2017
A new study has shown that HIV-infected women do not use statins as recommended by the most recent guidelines. Control of blood lipid levels to prevent heart disease is especially important in HIV-positive women, and they ...

2011 to 2014 saw increase in use of high-intensity statins after MI

June 4, 2017
(HealthDay)—From 2011 to 2014 there was an increase in the use of high-intensity statins following hospitalization for myocardial infarction (MI), according to a study published in the June 6 issue of the Journal of the ...

Newly diagnosed diabetes increases risk of heart attack, stroke even among statin users

May 18, 2016
Postmenopausal women with newly diagnosed diabetes have a significantly increased risk of atherosclerotic cardiovascular disease whether or not they take statin drugs, according to the results of a new study led by researchers ...

Recommended for you

Drug now in clinical trials for Parkinson's strengthens heart contractions in animals

July 20, 2018
A drug currently in clinical trials for treating symptoms of Parkinson's disease may someday have value for treating heart failure, according to results of early animal studies by Johns Hopkins Medicine researchers.

'Good cholesterol' may not always be good

July 19, 2018
Postmenopausal factors may have an impact on the heart-protective qualities of high-density lipoproteins (HDL) - also known as 'good cholesterol' - according to a study led by researchers in the University of Pittsburgh Graduate ...

Using adrenaline in cardiac arrests results in less than 1 percent more people leaving hospital alive

July 18, 2018
A clinical trial of the use of adrenaline in cardiac arrests has found that its use results in less than 1% more people leaving hospital alive—but almost doubles the risk of severe brain damage for survivors of cardiac ...

Omega 3 supplements have little or no heart or vascular health benefit: review

July 17, 2018
New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death.

Researchers discover new genes associated with heart function

July 17, 2018
A new study from an international research team, led by Dr. Yalda Jamshidi at St George's, University of London, has identified new genes associated with heart function and development.

Southern diet could be deadly for people with heart disease

July 12, 2018
People with a history of heart disease who eat a traditional Southern diet are more likely to die than those who follow a Mediterranean dietary pattern, according to new research.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.