Gender disparities in utilization of statins for low density lipoprotein management across the spectrum of atherosclerotic cardiovascular disease: Insights from the houston methodist cardiovascular disease learning health system registry

Abstract

Introduction: Lower statin utilization is reported among women compared to men, however large-scale studies evaluating gender disparities in LDL-C management in individuals with ASCVD and its subtypes remain limited, particularly across age and racial/ethnic subgroups. In this study, we address this knowledge gap using data from a large US healthcare system.

Methods: All adult patients with established ASCVD in the Houston Methodist Learning Health System Registry during 2016-2022 were included. Statin use and dose were extracted from the database. The association between gender and statin utilization was evaluated using multivariate logistic regression analyses in patients with ASCVD overall, across ASCVD subtypes, and by age, racial/ethnic subgroups, and socioeconomic risk factors.

Results: A total of 97,819 patients with prevalent ASCVD were included. Women with ASCVD had lower utilization of any statin (64.3% vs 72.6 %; p < 0.001) and high-intensity statin (29.8% vs 42.5 % p < 0.001) compared with men. In fully adjusted models, women had 40 % lower odds of any (adjusted odds ratio [aOR]:0.58, 95 % CI 0.57-0.60) and high-intensity statin use (aOR:0.59, 0.57-0.61) relative to men. Women were also less likely to have guideline-recommended LDL-C < 70 mg/dL (30.2% vs 42.7 %; p < 0.01). These differences persisted across age, racial/ethnic and socioeconomic subgroups.

Conclusion: Significant gender disparities exist in contemporary lipid management among patients with ASCVD, with women being less likely to receive any and high-intensity statin and achieving guideline defined LDL-C goal compared with men across age and racial/ethnic subgroups. These disparities underscore the need to further understand potential socioeconomic drivers of the observed lower statin uptake in women.

Keywords: ASCVD; Disparities; Equity; Gender; Prevention; Statin.

Graphical abstract

Fig. 1

Flowchart detailing inclusion of study population based on eligibility criteria. CAD=coronary artery disease; PAD=peripheral artery disease; ASCVD=Atherosclerotic cardiovascular disease.

Fig. 2

Utilization of statins in patients with atherosclerotic cardiovascular disease, stratified by gender.

Fig. 3

Odds of statin utilization in women vs men with atherosclerotic cardiovascular disease, stratified by age, race/ethnicity, adi quintiles and cardiovascular risk factors:A) Multi-variate adjusted odds of any statin utilization in women compared with men, B) Multi-variate adjusted odds of high-intensity statin utilization in women compared with men. Odds of statin utilization after adjusting for age, race/ethnicity, insurance status, ADI, chronic kidney disease, cerebrovascular disease, diabetes mellitus, obesity, smoking, hypertension, heart failure, charlson-comorbidity index, non-statin lipid lowering meds.

Fig. 4

Yearly trends of statin use in women vs men with atherosclerotic cardiovascular disease.