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Gender differences in lipid management, LDL-C goal attainment, and prescribing practices
Natasha Vartak1, Caroline Ong1, Xueqi Huang2
1Northwell Health, Cardiovascular Institute, New Hyde Park, NY, USA (Drs Vartak, Ong, Weintraub, Parikh, Rosen, and Gianos).
Insights
Women face significant disparities in lipid management, receiving less aggressive treatment and achieving lower LDL-C goals than men. Provider gender did not influence these lipid treatment gaps, highlighting a need for targeted interventions for women.
Area of Science:
- Cardiology
- Health Disparities
- Pharmacotherapy
Background:
- Lipid lowering is crucial for reducing atherosclerotic cardiovascular disease (ASCVD) morbidity and mortality.
- Despite guideline-recommended therapies, gender disparities persist in lipid management.
- Women are less likely to receive aggressive treatment and achieve optimal low-density lipoprotein cholesterol (LDL-C) levels.
Purpose of the Study:
- To investigate if provider gender influences lipid treatment gaps.
- To analyze gender-based differences in lipid management and LDL-C goal attainment.
Main Methods:
- Retrospective chart review of 364,021 adults from 2022-2023.
- Abstraction of demographic, clinical, and prescribing data from electronic health records.
- Definition of optimal LDL-C based on ASCVD risk.
Main Results:
- Women had higher mean LDL-C (108 vs 102 mg/dL) and lower LDL-C <100 mg/dL attainment (41% vs 47%) compared to men.
- Among those with ASCVD, women had significantly lower LDL-C <70 mg/dL attainment (31% vs 47%).
- Women were less likely to be prescribed statins (26% vs 33%) and high-intensity statins (23% vs 31%) than men; provider gender showed no impact.
Conclusions:
- Women with or at risk for ASCVD experience lower rates of lipid-lowering therapy prescription and LDL-C goal attainment.
- Existing gender disparities in lipid management require targeted interventions.
- Provider gender does not explain the observed disparities in lipid treatment for women.
Background:
A large evidence base supports lipid lowering to reduce atherosclerotic cardiovascular disease (ASCVD) morbidity and mortality. Despite guideline-recommended lipid-lowering therapies (LLT), gender-based disparities in lipid management persist, with women less likely to be treated aggressively and achieve optimal low-density lipoprotein cholesterol (LDL-C) levels.
Objective:
We aimed to investigate whether provider gender impacted lipid treatment gaps.
Methods:
We conducted a retrospective chart review of 364,021 adults within a large health system who underwent lipid testing between 2022 and 2023. Demographic, clinical, and prescribing data were abstracted from electronic health records. Optimal LDL-C was defined based on ASCVD risk.
Results:
Women had higher mean LDL-C (108 vs 102 mg/dL, P < .0001) and were less likely to achieve an LDL-C of <100 mg/dL (41% vs 47%, P < .0001) compared to men. Among those with ASCVD, only 31% of women vs 47% of men achieved an LDL-C <70 mg/dL (P < .0001). Women were less likely to be prescribed statins (26% vs 33%, P < .0001) in the overall population and high-intensity statins (23% vs 31%, P < .0001) in the ASCVD population than men. No prescribing difference was noted between male and female providers across specialties.
Conclusion:
Women with or at risk for ASCVD experience lower rates of LLT prescription and LDL-C goal attainment compared to men. These disparities underscore the need for targeted interventions to improve LDL-C goal attainment in women.
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