Despite recent efforts to eliminate sex-based treatment differences in cardiovascular care, women remain less likely to receive a high-intensity statin following myocardial infarction (MI), according to a study published online April 16 in the Journal of the American College of Cardiology.
Researchers studied nearly 90,000 people who experienced MI in 2014 and 2015 and filled a prescription for a statin within 30 days of hospital discharge. Among those individuals, 56 percent of men and 47 percent of women received high-intensity doses—atorvastatin 40 to 80 mg and rosuvastatin 20 to 40 mg.
American College of Cardiology/American Heart Association guidelines recommend the use of high-intensity statins for both women and men less than 75 years old for the secondary prevention of heart attack.
“Prior studies have found that women are less likely than men to receive treatment with statins following a heart attack,” lead author Sanne A.E. Peters, PhD, a research fellow at the University of Oxford, said in a press release. “Our study shows that even when women receive statins, these continue to be in lower intensities than the guidelines recommend. The underutilization of these drugs in women was not explained by sex differences in demographics, comorbidities or healthcare utilization.”
The study included 16,898 U.S. adults below 65 years old on commercial health insurance and 71,358 older than 65 on Medicare.
Importantly, the authors noted the proportion of beneficiaries whose first statin prescription fill was for a high-intensity dose increased from 27 to 60 percent in men from 2007 to 2015. The proportion of women prescribed a high-intensity statin increased from 22 to 50 percent over that same timeframe, so treatment for both genders improved but a gap persisted. There was no evidence of the gap shrinking after the 2013 ACC/AHA guidelines specified that no sex-based difference in statin dosage following MI should exist.
“While we found that the magnitude of the sex difference in the use of high-intensity statins after heart attack was larger among the youngest and oldest patients and among those without comorbidities, women were consistently less intensively treated across a broad range of patient characteristics,” Peters said. “This gap between our youngest and oldest patients is concerning because the oldest are at the highest risk and young women have been shown to have the slowest rate of decline in heart disease rates in the United States. The underutilization of high-intensity statins in women can be expected to result in a substantial number of preventable vascular events.”
The researchers couldn’t identify specific reasons clinicians may have prescribed lower-intensity statins. However, they said a previous study has shown that clinicians may perceive women to be at lower risk of heart disease, contributing to less aggressive treatment.
In a related editorial, three researchers from Rush Medical College in Chicago pointed out women are more likely to present with nonobstructive coronary artery disease, which is not benign but may be deemed less significant and therefore treated less aggressively.
“We need to continue to expand our understanding of the difference in pathophysiology of IHD (ischemic heart disease) in women through sex-specific research,” wrote Annabelle Santos Volgman, MD, and colleagues. “The unique barriers facing both women and men with regard to receiving evidence-based, guideline-recommended care should be characterized. We think sex should matter, as well as age, race and ethnicities, when it comes to patient care and adherence to guidelines.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.