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Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery
Agnes Koczo1, Jianhui Zhu1, Floyd Thoma1
1University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA.
Insights
Women with atherosclerotic cardiovascular disease (ASCVD) received less guideline-directed statin intensity (GDSI) and had higher ASCVD event risks. Sex-specific interventions are crucial for equitable ASCVD prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Equity
Background:
- Current guidelines advocate high-intensity statins for atherosclerotic cardiovascular disease (ASCVD).
- Sex-based disparities in guideline-directed statin intensity (GDSI) and ASCVD outcomes may exist.
- Understanding these differences is vital for optimizing cardiovascular care.
Purpose of the Study:
- To investigate sex-based differences in GDSI utilization among patients with established coronary artery disease.
- To evaluate the association between GDSI and recurrent ASCVD events, stratified by sex.
- To identify potential gaps in cardiovascular disease prevention strategies for women.
Main Methods:
- A retrospective cohort study analyzed electronic medical records of 45,949 patients with coronary artery disease from 2010-2022.
- Statin use was categorized into GDSI,
- Recurrent myocardial infarction (MI), stroke/TIA, and all-cause mortality were assessed using Cox regression, stratified by sex.
Main Results:
- Women comprised 31% of the cohort and presented with more comorbidities like diabetes.
- Women were less likely than men to receive GDSI (61.6% vs. 65.8%) and achieve LDL-C <70 mg/dL (41% vs. 49%).
- Despite GDSI lowering event rates in both sexes, women on GDSI had a higher risk of MI, stroke, and mortality compared to men.
Conclusions:
- Women with coronary artery disease are less likely to receive optimal statin therapy and face higher risks of recurrent cardiovascular events.
- This highlights a need for sex-specific strategies to improve GDSI implementation and achieve guideline-recommended lipid targets.
- Addressing these disparities is essential for equitable and effective ASCVD prevention in women.
Introduction:
Current guidelines recommend using high-intensity statins in patients with atherosclerotic cardiovascular disease (ASCVD). Guideline directed statin intensity (GDSI) implementation and ASCVD outcomes may differ by sex. We evaluated sex-based differences in GDSI use and recurrent ASCVD outcomes in a large healthcare network.
Methods:
Using electronic medical records, we assessed statin use and intensity in a cohort of patients with established coronary artery disease (coronary artery bypass grafting or percutaneous coronary intervention) between 2010-2022. Statins were categorized into GDSI (high intensity),
Results:
We amassed data from 45,949 patients, of which 31 % were women. Women had more diabetes (29 % vs 24 %) and higher low density lipoprotein cholesterol [LDL-C] (94.9 ± 40.8 vs 87.6 ± 37.1 mg/dL) than men. During a follow-up period of ∼5 years, women were less likely to be started on GDSI (61.6 % vs 65.8 %, p<0.01) and achieve LDL-C<70mg/dL (41 % vs and 49 %, p<0.01) as compared to men. GDSI use lowered IRs for all outcomes in both sexes. As compared to men, women on GDSI had higher risk of MI (HR 1.21 [1.12-1.31)], stroke (1.21 [1.08-1.34] and mortality (1.12 [1.05-1.20]), all p<0.01).
Conclusions:
In a contemporary cohort of patients with coronary artery disease, women were less likely to be prescribed GDSI than men and less likely to achieve guideline concordant LDL-C<70mg/dL. This was associated with a higher risk of recurrent ASCVD events in women as compared to men. More sex specific interventions are needed to ensure adequate preventive treatment for both sexes.
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