Nanna Michael G, Wang Tracy Y, Xiang Qun, Goldberg Anne C, Robinson Jennifer G, Roger Veronique L, Virani Salim S, Wilson Peter W F, Louie Michael J, Koren Andrew, Li Zhuokai, Peterson Eric D, Navar Ann Marie
Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., T.Y.W., Q.X., Z.L., E.D.P., A.M.N.).
Department of Medicine, Washington University, St. Louis, MO (A.C.G.).
Circ Cardiovasc Qual Outcomes. 2019 Aug;12(8):e005562. doi: 10.1161/CIRCOUTCOMES.118.005562. Epub 2019 Aug 16.
Female patients have historically received less aggressive lipid management than male patients. Contemporary care patterns and the potential causes for these differences are unknown.
Examining the Patient and Provider Assessment of Lipid Management Registry-a nationwide registry of outpatients with or at risk for atherosclerotic cardiovascular disease-we compared the use of statin therapy, guideline-recommended statin dosing, and reasons for undertreatment. We specifically analyzed sex differences in statin treatment and guideline-recommended statin dosing using multivariable logistic regression. Among 5693 participants (43% women) eligible for 2013 American College of Cardiology/American Heart Association Cholesterol Guideline-recommended statin treatment, women were less likely than men to be prescribed any statin therapy (67.0% versus 78.4%; P<0.001) or to receive a statin at the guideline-recommended intensity (36.7% versus 45.2%; P<0.001). Women were more likely to report having previously never been offered statin therapy (18.6% versus 13.5%; P<0.001), declined statin therapy (3.6% versus 2.0%; P<0.001), or discontinued their statin (10.9% versus 6.1%; P<0.001). Women were also less likely than men to believe statins were safe (47.9% versus 55.2%; P<0.001) or effective (68.0% versus 73.2%; P<0.001) and more likely to report discontinuing their statin because of a side effect (7.9% versus 3.6%; P<0.001). Sex differences in both overall and guideline-recommended intensity statin use persisted after adjustment for demographics, socioeconomic factors, clinical characteristics, patient beliefs, and provider characteristics (adjusted odds ratio, 0.70; 95% CI, 0.61-0.81; P<0.001; and odds ratio, 0.82; 95% CI, 0.73-0.92; P<0.01, respectively). Sex differences were consistent across primary and secondary prevention indications for statin treatment.
Women eligible for statin therapy were less likely than men to be treated with any statin or guideline-recommended statin intensity. A combination of women being offered statin therapy less frequently, while declining and discontinuing treatment more frequently, accounted for these sex differences in statin use.
历史上，女性患者接受的血脂管理不如男性患者积极。目前的护理模式以及造成这些差异的潜在原因尚不清楚。
通过研究患者及提供者血脂管理评估登记处（一个全国性的有动脉粥样硬化性心血管疾病或有患病风险的门诊患者登记处），我们比较了他汀类药物治疗的使用情况、指南推荐的他汀类药物剂量以及治疗不足的原因。我们使用多变量逻辑回归专门分析了他汀类药物治疗和指南推荐的他汀类药物剂量方面的性别差异。在5693名符合2013年美国心脏病学会/美国心脏协会胆固醇指南推荐的他汀类药物治疗条件的参与者中（43%为女性），女性接受任何他汀类药物治疗的可能性低于男性（67.0%对78.4%；P<0.001），或接受指南推荐强度他汀类药物治疗的可能性低于男性（36.7%对45.2%；P<0.001）。女性更有可能报告此前从未接受过他汀类药物治疗（18.6%对13.5%；P<0.001）、拒绝他汀类药物治疗（3.6%对2.0%；P<0.001）或停用他汀类药物（10.9%对6.1%；P<0.001）。女性也比男性更不相信他汀类药物是安全的（47.9%对55.2%；P<0.001）或有效的（68.0%对73.2%；P<0.001），并且更有可能报告因副作用而停用他汀类药物（7.9%对3.6%；P<0.001）。在对人口统计学、社会经济因素、临床特征、患者信念和提供者特征进行调整后，总体和指南推荐强度的他汀类药物使用方面的性别差异仍然存在（调整后的优势比为0.70；95%置信区间为0.61-0.81；P<0.001；优势比分别为0.82；95%置信区间为0.73-0.92；P<0.01）。他汀类药物治疗的一级和二级预防指征中的性别差异是一致的。
符合他汀类药物治疗条件的女性接受任何他汀类药物或指南推荐强度他汀类药物治疗的可能性低于男性。女性接受他汀类药物治疗的频率较低，同时拒绝和停止治疗的频率较高，这些因素共同导致了他汀类药物使用方面的性别差异。
