美国心肌梗死后高强度他汀类药物使用的性别差异。

Sex Differences in High-Intensity Statin Use Following Myocardial Infarction in the United States.

机构信息

The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.

Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.

出版信息

J Am Coll Cardiol. 2018 Apr 24;71(16):1729-1737. doi: 10.1016/j.jacc.2018.02.032.

DOI:10.1016/j.jacc.2018.02.032

PMID:29673463

Abstract

BACKGROUND

Historically, women have been less likely than men to receive guideline-recommended statin therapy for the secondary prevention of myocardial infarction (MI).

OBJECTIVES

The authors examined contemporary sex differences in prescription fills for high-intensity statin therapy following an MI, overall and across population subgroups, and assessed whether sex differences were attenuated following recent efforts to reduce sex disparities in the use of cardiovascular disease preventive therapies.

METHODS

The authors studied 16,898 (26% women) U.S. adults <65 years of age with commercial health insurance in the MarketScan database, and 71,358 (49% women) U.S. adults ≥66 years of age with government health insurance through Medicare who filled statin prescriptions within 30 days after hospital discharge for MI in 2014 to 2015. The authors calculated adjusted women-to-men risk ratios and 95% confidence intervals (CIs) for filling a high-intensity statin prescription (i.e., atorvastatin 40 to 80 mg, and rosuvastatin 20 to 40 mg) following hospital discharge for MI.

RESULTS

In 2014 to 2015, 56% of men and 47% of women filled a high-intensity statin following hospital discharge for MI. Adjusted risk ratios for filling a high-intensity statin comparing women with men were 0.91 (95% CI: 0.90 to 0.92) in the total population, 0.91 (95% CI: 0.89 to 0.92) among those with no prior statin use, and 0.87 (95% CI: 0.85 to 0.90) and 0.98 (95% CI: 0.97 to 1.00) for those taking low/moderate-intensity and high-intensity statins prior to their MI, respectively. Women were less likely than men to fill high-intensity statins within all subgroups analyzed, and the disparity was largest in the youngest and oldest adults and for those without prevalent comorbid conditions.

CONCLUSIONS

Despite recent efforts to reduce sex differences in guideline-recommended therapy, women continue to be less likely than men to fill a prescription for high-intensity statins following hospitalization for MI.

摘要

背景

历史上，女性接受指南推荐的用于心肌梗死（MI）二级预防的他汀类药物治疗的可能性低于男性。

目的

作者研究了 MI 后高强度他汀类药物处方的当代性别差异，包括总体情况和人群亚组，并评估了在最近减少心血管疾病预防治疗中性别差异的努力后，性别差异是否减弱。

方法

作者研究了 MarketScan 数据库中 16898 名（26%为女性）年龄<65 岁的有商业健康保险的美国成年人和 Medicare 政府健康保险的 71358 名（49%为女性）年龄≥66 岁的美国成年人，他们在 2014 年至 2015 年期间在 MI 出院后 30 天内开出他汀类药物处方。作者计算了出院后 MI 后开出高强度他汀类药物处方（即阿托伐他汀 40 至 80 毫克，和瑞舒伐他汀 20 至 40 毫克）的女性与男性的调整后的风险比和 95%置信区间（CI）。

结果

2014 年至 2015 年，56%的男性和 47%的女性在 MI 出院后开出了高强度他汀类药物。在总人群中，女性与男性相比，开出高强度他汀类药物的风险比为 0.91（95%CI：0.90 至 0.92），在无先前他汀类药物使用的人群中为 0.91（95%CI：0.89 至 0.92），而在 MI 前服用低/中强度和高强度他汀类药物的人群中，风险比分别为 0.87（95%CI：0.85 至 0.90）和 0.98（95%CI：0.97 至 1.00）。在分析的所有亚组中，女性开出高强度他汀类药物的可能性均低于男性，在最年轻和最年长的成年人以及没有常见合并症的人群中，这种差异最大。