title: Statin use prior to first myocardial infarction in contemporary patients: Inefficient and not gender equitable.
abstract: OBJECTIVE
  Guidelines recommend initiating primary prevention with statins to those at highest cardiovascular risk. We assessed the gender-specific implementation and effectiveness of this risk-guided approach.
  
  
  METHODS
  We identified 1399 consecutive patients without known cardiovascular disease or diabetes hospitalized with a first myocardial infarction (MI) in Denmark. Statin use before MI was assessed, and cardiovascular risk was calculated using SCORE (Systematic COronary Risk Evaluation).
  
  
  RESULTS
  Among patients with first MI, 36% were women. Compared with men, they were older (mean 72 vs. 65years) but had a lower estimated risk (median 3.4% vs. 6.7%, SCORE high-risk model in the statin-naïve patients). Statin therapy had been initiated in 12% of women and 10% of men prior to MI. After adding 1.5mmol/L to the total cholesterol concentration of those already on statins, the estimated pre-treatment risk was much lower in women than men (median 3.8% vs. 9.2%, SCORE high-risk model), and only 29% of women would have passed the risk-based treatment threshold defined by the European guidelines (SCORE ≥5%). Estimated risk and statin use correlated directly in men but not in women. Only ~5% of first MI are prevented by the current use of statins in people without diabetes.
  
  
  CONCLUSIONS
  In people destined for a first MI, statin therapy is uncommon and prevents few events. Lower-risk women receive as much statins as higher risk men. This gender disparity and inefficient targeting of statins to those at highest risk indicate that risk scoring is not widely used in routine clinical practice in Denmark.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Imra
authors.initials: I
authors.lastname: Kulenovic
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark. Electronic address: Martin.bodtker.mortensen@ki.au.dk.
authors.forename: Martin Bødtker
authors.initials: MB
authors.lastname: Mortensen
authors.affiliation: Department of Medicine, Regional Hospital Randers, Denmark.
authors.forename: Jette
authors.initials: J
authors.lastname: Bertelsen
authors.affiliation: Department of Medicine, Regional Hospital Herning, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: May
authors.affiliation: Department of Cardiology, Regional Hospital Horsens, Denmark.
authors.forename: Karen Kaae
authors.initials: KK
authors.lastname: Dodt
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Kanstrup
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Erling
authors.initials: E
authors.lastname: Falk
mesh_terms: D000368:Aged; D003718:Denmark; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D011322:Primary Prevention; D018570:Risk Assessment; D012737:Sex Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular disease; Gender; Myocardial infarction; Prevention; SCORE; Statin