Sex Differences in High-Intensity Statin Use Following Myocardial Infarction in the United States

Peters, Sanne A.E.; Colantonio, Lisandro D.; Hong, Zhao; Bittner, Vera; Dai, Yuling; Farkouh, Michael E.; Monda, Keri L.; Safford, Monika M.; Muntner, Paul; Woodward, Mark

doi:10.1016/j.jacc.2018.02.032

Cited by 129 publications

(85 citation statements)

References 27 publications

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“…However, this corresponds with data showing female patients often underestimate their risk of cardiovascular disease . Additionally, a recent study found that women were less likely than men to fill a prescription for a high‐intensity statin following a myocardial infarction . It has been theorized that this difference could be related to the atypical presentation of cardiovascular events among women.…”

Section: Discussionsupporting

confidence: 73%

“…10 Additionally, a recent study found that women were less likely than men to fill a prescription for a high-intensity statin following a myocardial infarction. 11 It has been theorized that this difference could be related to the atypical 12 However, further study is needed to investigate other factors contributing to the disparity in gender outcomes within this clinic.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Assessment of chronic disease management among patients with diabetes and coronary artery disease receiving care in a cardiology clinic

Pearson

Shakowski

Griend

et al. 2018

J Am Coll Clin Pharm

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Background Patients with coronary artery disease (CAD) often have multiple comorbidities (eg, diabetes, hypertension, and hyperlipidemia). It is unclear if these comorbidities are adequately managed among patients established in a cardiology clinic. Methods This retrospective, observational study used electronic medical record data from 1 January 2014 to 31 October 2017 to examine the achievement of five chronic disease quality measures (glycated hemoglobin, A1C ≤ 9.0%, blood pressure, BP < 140/90 mm Hg, antiplatelet agent, moderate/high‐intensity statin, and annual influenza vaccine). Additional measures of optimal care were also assessed (A1C ≤ 8.0%, A1C ≤ 7.0%, blood pressure < 130/80 mm Hg, high‐intensity statin, pneumococcal polysaccharide vaccination (PPSV23)). Patients were identified from the University of Colorado Health Cardiac and Vascular Center (CVC) with CAD, diabetes, and at least two CVC visits within a 24‐month period (n = 295). Results The primary outcome measures with highest achievement were for antiplatelet and moderate/high‐intensity statin prescribing (91% and 89%, respectively). The measure with lowest achievement was receipt of influenza vaccination (69%). Women were less likely than men to achieve at least four of the five measures (adjusted odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24‐0.80). Patients with two or more primary care provider (PCP) visits within the past year were more likely to achieve at least four measures compared with patients with less than two PCP visits (adjusted OR, 2.22; 95% CI, 1.14‐4.31). When applying optimal measures, 41% of patients achieved an A1C ≤7%, 52% achieved a blood pressure of <130/80 mm Hg, and 66% were prescribed high‐intensity statins. Conclusions Achievement for chronic care quality measures was high but performance could be improved, especially among women and patients with infrequent PCP visits. Increased collaboration and communication between primary care and cardiology may improve care for these patients.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 98%

Assessment of chronic disease management among patients with diabetes and coronary artery disease receiving care in a cardiology clinic

Pearson

Shakowski

Griend

et al. 2018

J Am Coll Clin Pharm

View full text Add to dashboard Cite

show abstract

“…Cardiovascular disease (CVD) is recognized as the leading cause of death among both genders [1], but there are unique pathophysiological and clinical features of CVD in women [2,3]. In the United States of America (USA), gender disparities in CVD are long-standing and persistent in time to diagnosis [4,5], guideline-directed treatments [2,3,[6][7][8][9][10][11][12][13][14][15], and outcomes [2,3,[10][11][12][13][14]16], although the overall prevalence of CVD in women is less than in men (44.7 versus 51.2%) [1]. When considering racial/ethnic CVD prevalence, the highest CVD prevalence rates are among Black males (60.1%) and Black females (57.1%), while the lowest prevalence rates are among NH Asian males (47.4%) and NH Asian females (37.2%) [1].…”

Section: Introductionmentioning

confidence: 99%

Disparities in Cardiovascular Care and Outcomes for Women From Racial/Ethnic Minority Backgrounds

Balla

Gomez

Rodríguez

2020

Curr Treat Options Cardio Med

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Purpose of review Racial, ethnic, and gender disparities in cardiovascular care are well-documented. This review aims to highlight the disparities and impact on a group particularly vulnerable to disparities, women from racial/ethnic minority backgrounds. Recent findings Women from racial/ethnic minority backgrounds remain underrepresented in major cardiovascular trials, limiting the generalizability of cardiovascular research to this population. Certain cardiovascular risk factors are more prevalent in women from racial/ethnic minority backgrounds, including traditional risk factors such as hypertension, obesity, and diabetes. Female-specific risk factors including gestational diabetes and preeclampsia as well as non-traditional psychosocial risk factors like depressive and anxiety disorders, increased child care, and familial and home care responsibility have been shown to increase risk for cardiovascular disease events in women more so than in men, and disproportionately affect women from racial/ethnic minority backgrounds. Despite this, minimal interventions to address differential risk have been proposed. Furthermore, disparities in treatment and outcomes that disadvantage minority women persist. The limited improvement in outcomes over time, especially among non-Hispanic Black women, is an area that requires further research and active interventions. Summary Understanding the lack of representation in cardiovascular trials, differential cardiovascular risk, and disparities in treatment and outcomes among women from racial/ethnic minority backgrounds highlights opportunities for improving cardiovascular care among this particularly vulnerable population.

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“…8 -14 Of these, we are aware of only a few studies that extend beyond the year that the guideline was published and even then only include narrowly defined populations (eg, only privately insured and/or Medicare patients, those covered by a single insurer, those within 30 days postmyocardial infarction (MI)). 10,11,13,14 We examined nationally representative data for the years 2008 through 2016 to determine whether there has been an increase in use of statins in persons with a history of ASCVD following the publication of the ACC/AHA guideline in 2013. Prior studies have tended to focus on narrower samples whereas ours contains a nationally representative sample of adults with any history of ASCVD, the wider population targeted by the ACC/AHA guideline.…”

mentioning

confidence: 99%

Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal

et al. 2019

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Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in the United States. The purpose of this study is to examine the rates of statin use for secondary prevention of ASCVD events in the United States over the last decade and determine whether disparities in the treatment of ASCVD still persist among women and racial/ethnic minorities. Methods: We conducted a trend analysis using data from 2008 through 2016 to describe age-adjusted trends in the use of statins for secondary prevention using the Medical Expenditure Panel Survey. We also conducted a multivariable logistic regression analysis to determine whether sociodemographic characteristics are associated with statin use during the 3 years that followed the publication of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline (2014 through 2016). Results: The prevalence of statin use among those with a history of ASCVD remained unchanged from 2008 through 2016. In 2014 to 2016, more than 40% of those aged 40 years and older with a history of ASCVD did not use statins, corresponding to approximately 9.5 million Americans. Increasing age and having been diagnosed with high cholesterol (odds ratio [OR], 6.22; P < .001) were associated with higher odds of statin use while being female (OR, 0.65; P < .001) or Hispanic (OR, 0.69; P ‫؍‬ .011) were associated with lower odds of statin use. Conclusions: Our study found there was no increase in the national rates of statin use following the ACC/AHA 2013 secondary prevention guideline and the availability of generic statins. Significant gender and ethnic disparities in ASCVD treatment remained in the United States.

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Sex Differences in High-Intensity Statin Use Following Myocardial Infarction in the United States

Abstract: Despite recent efforts to reduce sex differences in guideline-recommended therapy, women continue to be less likely than men to fill a prescription for high-intensity statins following hospitalization for MI.

Cited by 129 publications

References 27 publications

Assessment of chronic disease management among patients with diabetes and coronary artery disease receiving care in a cardiology clinic

Assessment of chronic disease management among patients with diabetes and coronary artery disease receiving care in a cardiology clinic

Disparities in Cardiovascular Care and Outcomes for Women From Racial/Ethnic Minority Backgrounds

Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal

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