Gender Disparities in Evidence-Based Statin Therapy in Patients With Cardiovascular Disease

Virani, Salim S.; Woodard, Lauren E.; Ramsey, David J.; Urech, Tracy H.; Akeroyd, Julia M.; Shah, Tina; Deswal, Anita; Bozkurt, Biykem; Ballantyne, Christie M.; Petersen, Laura A.

doi:10.1016/j.amjcard.2014.09.041

Cited by 155 publications

(100 citation statements)

References 16 publications

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“…The AHA/ACC and the National Institute for Health and Care Excellence clinical guidelines recommend intensive LLT for patients with CAD in general 2, 36. Interestingly, LLT is only intensified in 25% of CAD patients in daily practice 3, 4, 37. This may be because physicians tend to treat solely patients who they believe to be at high risk for recurrent vascular events with intensive LLT.…”

Section: Discussionmentioning

confidence: 99%

“…This may be because physicians tend to treat solely patients who they believe to be at high risk for recurrent vascular events with intensive LLT. For example, men, patients with high low‐density lipoprotein‐cholesterol (LDL‐c) levels, and those with an ST‐elevation MI are more often treated with a high‐dose statin 3, 4. This is understandable because those at high risk for recurrent MACE benefit the most from intensive LLT in absolute terms.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the American College of Cardiology/American Heart Association (ACC/AHA) clinical guideline recommends intensive lipid lowering in patients with CAD unless characteristics like older age, history of statin intolerance, or serious comorbidities diminish safety of intensive LLT 2. Nevertheless, high‐dose statin treatment rates are low, especially in women 3, 4. This might be attributed to a dose‐related higher incidence of adverse effects like myopathy, new‐onset diabetes mellitus, and elevation of liver transaminits 5, 6.…”

Section: Introductionmentioning

confidence: 99%

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Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Stam‐Slob

Graaf

Greving

et al. 2017

JAHA

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BackgroundA validated prediction model estimates the absolute benefit of intensive versus standard lipid‐lowering therapy (LLT) with statins on next major cardiovascular events for individual patients with coronary artery disease. We aimed to assess whether targeting intensive LLT therapy to coronary artery disease patients with the highest predicted absolute benefit is cost‐effective compared to treating all with standard or all with intensive LLT.Methods and ResultsA lifetime Markov model was constructed for coronary artery disease patients (n=10 000) with mean age 61 years. Number of major cardiovascular events, (non) vascular death, costs, and quality‐adjusted life years (QALYs) were estimated for the following strategies: (1) standard LLT for all (reference strategy); (2) intensive LLT for those with 5‐year absolute major cardiovascular events risk reduction (ARR) ≥3%, ≥2.3%, or ≥1.5% (corresponding to ≥20%, ≥15%, or ≥10% 5‐year major cardiovascular events risk); and (3) intensive LLT for all. With intensive LLT for those with ≥3% 5‐year ARR (13% of patients), 380 QALYs were gained for €2423/QALY. Using a threshold of ≥2.3% ARR (26% of patients), 630 QALYs were gained for €5653/QALY. Using a threshold of ≥1.5% ARR (56% of patients), 1020 QALYs were gained for €10 960/QALY. By treating all intensively, 1410 QALYs were gained (0.14 QALY per patient) for €17 223/QALY. With benefit‐based treatment, 0.16 to 0.17 QALY was gained per treated patient.ConclusionsIntensive LLT with statins for all coronary artery disease patients results in the highest overall QALY gain against acceptable costs. However, the number of QALYs gained with intensive LLT by statins in individual patients can be increased with selective benefit‐based treatment.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00327691 and NCT00159835

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Stam‐Slob

Graaf

Greving

et al. 2017

JAHA

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“…Female gender was independently associated with a lower likelihood of receiving statins. 50 Women who present with chest pain treated much less aggressively than men, who are more likely to be admitted to ICU; have cardiac enzymes drawn; emergency cardiology consult completed; and receive aspirin, heparin, nitroglycerin, and thrombolytics. Women most often receive controlled substances and anxiolytics.…”

Section: Resultsmentioning

confidence: 99%

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

2017

Critical Care Nurse

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Using written vignettes of homicides that differed only in sex of perpetrator, forensic psychiatrists and students diagnosed the defendant as legally insane significantly more often when perpetrator was a woman. 11World Health Organization 12 and US 13 research found most behavioral disorders (depression, anxiety) are diagnosed twice as often in women.Men receive more intensive treatments than women for common conditions. 14 85% of men vs 55% of women receive oral antihyperglycemics. 15 Despite the UK NICE guideline 27 13,16 (mandates "urgent referral to an oncologist" for painless macroscopic hematuria), 27% of women vs 10% of men had multiple consults before referral. Bladder cancer 5-year survival rate is 57% for men, 44% for women. 17,18 Female gender is independent risk factor for delayed referral and diagnosis of bladder and renal cancer. 19 TKA referral in patients with comparable osteoarthritis severity: physicians deny sex influences referral, but referral rate for men is 3 times that for women. Using identical standardized patients, 42% of physicians recommended TKA for the male, but not the female. Odds of primary care physicians recommending TKA for men was twice that for women; for orthopedic physicians, odds for men was 22 times that for women. 20Patients with osteoarthritis needing hip replacement, women less likely than men to receive 4 of 5 care stages: consult with general practitioner, specialist referral, orthopedic consult, wait listed. 21 Women have more disability before referral. 22Women have lower probability of referral to waiting list for kidney transplantation and longer delay between dialysis and waiting list compared to men. 23-25Women had significantly lower liver transplantation rates than men from 1997 to 2007 and greater deficit to men since. 26Women had pain years longer than men before referral to pain clinic, where women are prescribed minor tranquilizers, sedatives, or antidepressants vs analgesics and opioids for men. 27After abdominal surgery, physicians prescribed less pain medication for women compared to men; nurses gave less pain medication to women. 28After CABG, men received narcotics, women given sedatives. 29First report on gender attributes of pain: physicians minimized women's pain by attributing it to emotional causes. 30 80 physicians (44 men) and 113 nurses (103 women) more likely to treat male patients with opioids than females. Disparity greater for nurses than physicians. 31Despite ACC/AHA PAD guidelines, at discharge, women are significantly less likely than men to be prescribed 3 recommended therapies: statins, aspirin, and β-blockers. 32,33Women are offered surgical revascularization less often (36.4%) than men (53.8%) and are offered CEA less often at all ages. 34 When CEA is offered to women, it is often on a very delayed basis. Delays persist after adjusting for age, history, preoperative TIA, ABCD2 score, degree of stenosis, unilateral symptoms, and symptomatic stenosis. 34 Findings most concerning because female gender is a known, negative, independ...

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“…224,[226][227][228][229][230] Lower socioeconomic status, limited healthcare access, enrollment in lower-performing health plans, and dependence on Spanish language appear to account for some of these disparities in the health care of blacks and Hispanics. [227][228][229] Policies that improve access to prevention and treatment of hypercholesterolemia include those discussed above under healthy diet and physical activity, as well as those relating to healthcare access, quality, and affordability.…”

Section: Total Cholesterol (Not Prioritized Although Implied Within mentioning

confidence: 99%

Evidence-Based Policy Making: Assessment of the American Heart Association’s Strategic Policy Portfolio

Goldstein¹,

Antman²,

Arnett³

et al. 2016

Circulation

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Background-American Heart Association (AHA) public policy advocacy strategies are based on its Strategic Impact Goals.The writing group appraised the evidence behind AHA's policies to determine how well they address the association's 2020 cardiovascular health (CVH) metrics and cardiovascular disease (CVD) management indicators and identified research needed to fill gaps in policy and support further policy development. Methods and Results-The AHA policy research department first identified current AHA policies specific to each CVH metric and CVD management indicator and the evidence underlying each policy. Writing group members then reviewed each policy and the related metrics and indicators. The results of each review were summarized, and topic-specific priorities and overarching themes for future policy research were proposed. There was generally close alignment between current AHA policies and the 2020 CVH metrics and CVD management indicators; however, certain specific policies still lack a robust evidence base. For CVH metrics, the distinction between policies for adults (age ≥20 years) and children (<20 years) was often not considered, although policy approaches may differ importantly by age. Inclusion of all those <20 years of age as a single group also ignores important differences in policy needs for infants, children, adolescents, and young adults. For CVD management indicators, specific quantitative targets analogous to criteria for ideal, intermediate, and poor CVH are lacking but needed to assess progress toward the 2020 goal to reduce deaths from CVDs and stroke. New research in support of current policies needs to focus on the evaluation of their translation and implementation through expanded application of implementation science. Focused basic, clinical, and population research is required to expand and strengthen the evidence base for the development of new policies. Evaluation of the impact of targeted © 2016 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000410The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This policy statement was approved by the Advocacy Coordinating Committee February 23, 2016, and the American Heart Association Executive Committee on February 23, 2016. A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The American Heart Association requests that this document be cited as follows: Labarthe DR, Goldstein LB,...

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Gender Disparities in Evidence-Based Statin Therapy in Patients With Cardiovascular Disease

Cited by 155 publications

References 16 publications

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

Evidence-Based Policy Making: Assessment of the American Heart Association’s Strategic Policy Portfolio

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