Studies have shown gender disparities in cholesterol care in patients with cardiovascular
disease (CVD), with women less likely than men to have low-density lipoprotein cholesterol
levels <100 mg/dl. Whether this is related to a lower evidence-based statin or high-intensity
statin use is not known. We used a national cohort of 972,532 patients with CVD (coronary
heart disease, peripheral artery disease, and ischemic stroke) receiving care in 130
Veterans Health Administration facilities from October 1, 2010, to September 30, 2011,
to identify the proportion of male and female patients with CVD receiving any statin
and high-intensity statin. Women with CVD (n = 13,371) were less likely than men to
receive statins (57.6% vs 64.8%, p <0.0001) or high-intensity statins (21.1% vs 23.6%,
p <0.0001). Mean low-density lipoprotein cholesterol levels (99 vs 85 mg/dl) were
higher in women compared with men (p <0.0001). In adjusted models, female gender was
independently associated with a lower likelihood of receiving statins (odds ratio
0.68, 95% confidence interval 0.66 to 0.71) or high-intensity statins (odds ratio
0.76, 95% confidence interval 0.73 to 0.80). The median facility-level rate of statin
and high-intensity statin use among female patients (57.3% [interquartile range =
8.93%] for statin, 20% [interquartile range = 7.7%] for high-intensity statin use)
showed significant variation. In conclusion, women with CVD are less likely to receive
evidence-based statin and high-intensity statins compared with men, although, their
use remains low in both genders. There is a significant facility-level variation in
evidence-based statin or high-intensity statin use in female patients with CVD. With
the “statin dose-based approach” proposed by the recent cholesterol guidelines, these
results highlight areas for quality improvement.
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Article info
Publication history
Published online: October 11, 2014
Accepted:
September 30,
2014
Received in revised form:
September 30,
2014
Received:
August 15,
2014
Footnotes
This work was also supported by the Houston Veterans Affairs Health Services Research and Development Center for Innovations grant (grant HFP 90-020). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
See page 25 for disclosure information.
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Published by Elsevier Inc.
