Gender differences in lipid management, LDL-C goal attainment, and prescribing practices

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.

We aimed to investigate whether provider gender impacted lipid treatment gaps.

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.

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.

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.