Patient Sex and Physician Gender as Modifiers of Low-density Lipoprotein Cholesterol Control in High-risk Patients of Atherosclerotic Disease: A Cross-sectional Study

Abstract

Introduction: Inadequate management of low-density lipoprotein (LDL) cholesterol is more common in female patients than in male patients in the context of preventing atherosclerotic cardiovascular disease. Moreover, the effect of physician gender on patient outcomes has been acknowledged. However, to date, no study in Japan has investigated this issue or explored the potential interactions between patient sex and physician gender. This study aimed to assess disparities in achieving LDL cholesterol targets between male and female patients and examine the impact of the patient-physician gender dyad.

Methods: We conducted a cross-sectional study using electronic medical records from an urban Japanese clinic. Patients aged 40-79 years with coronary artery disease, noncardiogenic stroke, or diabetes mellitus were included in the study. The modified Poisson regression model with robust error variance was used, and patients were stratified by sex to evaluate the interaction between patient sex and physician gender.

Results: Among the 714 patients (44.1% women), female patients were less likely to achieve LDL cholesterol targets than male patients (70.7% male vs. 63.9% female). Adjusted analyses revealed that this trend persisted for female patients (adjusted prevalence ratio: 0.86, 95% confidence interval [CI]: 0.77-0.96). A notable interaction between patient sex and physician gender was observed; male patients managed by female physicians had lower LDL cholesterol target achievement than male patients managed by male physicians (adjusted prevalence ratio: 0.74 [95% CI: 0.62-0.88]).

Conclusions: Female patients were less likely to achieve LDL cholesterol targets, and patient-physician gender discordance was associated with poorer lipid management. These findings highlight the need for quality improvement interventions to address the disparity.

Keywords: Atherosclerotic cardiovascular disease; Evidence-practice gap; Gender concordance; LDL cholesterol; Primary and secondary prevention.

Figure 1.

Flow chart of patient selection.

Figure 2.

Results of regression models estimating the association between achievement of LDL cholesterol targets and patient sex LDL, low-density lipoprotein; CI, confidence interval; ref., reference.