title: Gender Disparities in Lipid-Lowering Therapy in Cardiovascular Disease: Insights from a Managed Care Population.
abstract: Numerous studies have documented the strong inverse relationship between low-density lipoprotein cholesterol (LDL-C) levels and atherosclerotic cardiovascular disease (ASCVD). However, women are less likely to be screened for hypercholesterolemia, receive lipid-lowering therapy (LLT), and achieve optimal LDL-C levels.
  
  
  
  Data were extracted from a U.S. administrative claims database between January 2008 and December 2012 for patients with established ASCVD. The earliest date of valid LDL-C value was defined as the index date. Patients were followed for ±12 months from the index date and were stratified by gender, by baseline LDL-C level, and whether they were initially treated with a LLT then propensity score matched by gender using demographic and clinical characteristics. Both descriptive statistics and logistic regression models were used to explore the association of gender with the frequency of LDL-C monitoring, LLT treatment initiation in initially untreated patients, and prescribing patterns in initially treated patients.
  
  
  
  A total of 76,414 subjects with established ASCVD were identified; 42% of the sample was women. In the unmatched cohort, 50.3% of men and 32.0% of women were prescribed a preindex statin (p < 0.0001). Among matched patients (n = 51,764), women initially treated with LLT were significantly less likely to receive a prescription for a higher potency LLT. Even among those with LDL-C levels above 160 mg/dL, women were more likely to discontinue LLT, odds ratio (95% confidence interval) 1.8 (1.2-2.3). Female gender and older age were significant predictors of discontinuation, and the potency of the index medication was the strongest predictor of dose titration. Initially untreated women were less likely to initiate LLT treatment than men, irrespective of index LDL-C levels (p < 0.0001).
  
  
  
  The observed disparities further reinforce the need for targeted efforts to reduce the gender gap for secondary prevention in women at high risk of cardiovascular disease.
authors.affiliation: 1 Division of Cardiovascular Medicine, Stanford University , Stanford, California.
authors.forename: Fatima
authors.initials: F
authors.lastname: Rodriguez
authors.affiliation: 2 Merck Sharp & Dohme Corp. , North Wales, Pennsylvania.
authors.forename: Temitope O
authors.initials: TO
authors.lastname: Olufade
authors.affiliation: 2 Merck Sharp & Dohme Corp. , North Wales, Pennsylvania.
authors.forename: Dena R
authors.initials: DR
authors.lastname: Ramey
authors.affiliation: 3 DataMed Solutions, LLC , New York, New York.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Friedman
authors.affiliation: 3 DataMed Solutions, LLC , New York, New York.
authors.forename: Prakash
authors.initials: P
authors.lastname: Navaratnam
authors.affiliation: 2 Merck Sharp & Dohme Corp. , North Wales, Pennsylvania.
authors.forename: Kim
authors.initials: K
authors.lastname: Heithoff
authors.affiliation: 4 Division of Cardiovascular Medicine, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: JoAnne M
authors.initials: JM
authors.lastname: Foody
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D014481:United States / Q000453:epidemiology
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D014280:Triglycerides