title: Statin Adherence: Does Gender Matter?
abstract: Cardiovascular disease (CVD) continues to be the leading cause of death for men and women in the USA. Statins have contributed significantly to noted declines in cardiovascular-related mortality in the last decade; however, the benefit of statins is inequitable across genders. Women continue to be less likely to take statins and to meet target LDL goals than men. As a possible contributing factor to this disparity, we explore the evidence for gender-based differences in provision of, and adherence to statins.
  
  
  
  Compared with men, women are less likely to adhere to statins. Potential reasons for this gender difference in use of statins can be observed across all phases of adherence including both intentional and unintentional non-adherence. Notable gender-specific contributing factors for statin non-adherence include decreased provider and patient awareness of CVD risk among women, higher risk of statin intolerance among women, and competing demands associated with family caregiving responsibilities. Similar to limitations in the broader CVD literature, there is inadequate inclusion of gender-specific analyses in statin-related trials. Gender-based disparities in statin adherence can be linked to both provider level, psychosocial, and medication intolerance factors. Interventions designed to improve statin adherence should take gender-specific challenges into consideration such as women being older at the time of increased CVD risk, higher rates of statin intolerance, and potentially greater caregiving responsibilities.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA. Karen.goldstein@duke.edu.|Division of General Internal Medicine, Duke University, Durham, NC, USA. Karen.goldstein@duke.edu.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Goldstein
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.|Division of General Internal Medicine, Duke University, Durham, NC, USA.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.|Department of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.|Division of General Internal Medicine, Duke University, Durham, NC, USA.|Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.|School of Nursing, Duke University, Durham, NC, USA.|Center for Population Health Science, Duke University, Durham, NC, USA.
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D055118:Medication Adherence; D012727:Sex Characteristics
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Gender; Medication adherence; Medication persistence; Statin medications