title: Gender disparities in evidence-based statin therapy in patients with cardiovascular disease.
abstract: 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.
authors.affiliation: Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas. Electronic address: virani@bcm.edu.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, Texas.
authors.forename: LeChauncy D
authors.initials: LD
authors.lastname: Woodard
authors.affiliation: Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, Texas.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ramsey
authors.affiliation: Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, Texas.
authors.forename: Tracy H
authors.initials: TH
authors.lastname: Urech
authors.affiliation: Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, Texas.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Akeroyd
authors.affiliation: Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Tina
authors.initials: T
authors.lastname: Shah
authors.affiliation: Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
authors.affiliation: Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, Texas.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors