title: Drivers of the Sex Disparity in Statin Therapy in Patients with Coronary Artery Disease: A Cohort Study.
abstract: Women are less likely to be prescribed statins than men. Existing reports explain only a fraction of this difference. We conducted a study to identify factors that account for sex differences in statin therapy among patients with coronary artery disease (CAD).
  
  
  
  We retrospectively studied 24,338 patients with CAD who were followed for at least a year between 2000 and 2011 at two academic medical centers. Women (9,006 / 37% of study patients) were less likely to either have initiated statin therapy (81.9% women vs. 87.7% men) or to have persistent statin therapy at the end of follow-up (67.0% women vs. 71.4% men). Women were older (72.9 vs. 68.4 years), less likely to have ever smoked (49.8% vs. 65.6%), less likely to have been evaluated by a cardiologist (57.5% vs. 64.5%) and more likely to have reported an adverse reaction to a statin (27.1% vs. 21.7%) (p < 0.0001 for all). In multivariable analysis, patients with history of smoking (OR 1.094; p 0.017), younger age (OR 1.013 / year), cardiologist evaluation (OR 1.337) and no reported adverse reactions to statins (OR 1.410) were more likely (p < 0.0001 for all) to have persistent statin therapy. Together, these four factors accounted for 90.4% of the sex disparity in persistent statin therapy.
  
  
  
  Several specific factors appear to underlie divergent statin therapy in women vs. men. Identifying such drivers may facilitate programmatic interventions and stimulate further research to overcome sex differences in applying proven interventions for cardiovascular risk reduction.
authors.affiliation: Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Huabing
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America.|Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Jorge
authors.initials: J
authors.lastname: Plutzky
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Maria
authors.initials: M
authors.lastname: Shubina
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America.|Brigham and Women's Hospital, Boston, Massachusetts, United States of America.|Harvard Clinical Research Institute, Boston, Massachusetts, United States of America.
authors.forename: Alexander
authors.initials: A
authors.lastname: Turchin
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors