Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.
Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Cardiovasc Drugs Ther. 2020 Dec;34(6):745-754. doi: 10.1007/s10557-020-07057-y. Epub 2020 Aug 25.
This study sought to investigate gender-based disparities in statin prescription rates and adherence among patients with peripheral arterial disease (PAD) and ischemic cerebrovascular disease (ICVD).
We identified patients with PAD or ICVD seeking primary care between 2013 and 2014 in the VA healthcare system. We assessed any statin use, high-intensity statin (HIS) use, and statin adherence among women with PAD or ICVD compared with men. We also compared proportion of days covered (PDC) as a measure of statin adherence; PDC ≥ 0.8 deemed a patient statin adherent. Association between statin use (or adherence) and odds of death or myocardial infarction (MI) at 12-month follow-up was also ascertained.
Our analyses included 192,219 males and 3188 females with PAD and 331,352 males and 10,490 females with ICVD. Women with PAD had lower prescription rates of any statin (68.5% vs. 78.7%, OR 0.68, 95% confidence interval (CI) 0.62-0.75), HIS (21.1% vs. 23.7%, OR 0.88, 95% CI 0.79-0.97), and lower statin adherence (PDC ≥ 0.8: 34.6% vs. 45.5%, OR 0.75, 95% CI 0.69-0.82) compared with men. Similar disparities were seen in ICVD patients. Among female patients with PAD or ICVD, statin adherence was associated with lower odds of MI (OR 0.76, 95% CI 0.59-0.98), while use of any statin (OR 0.71, 95% CI 0.56-0.91) and HIS (OR 0.68, 95% CI 0.48-0.97) was associated with lower odds of death at 12 months.
Women with PAD or ICVD had lower odds of receiving any statins, HIS, or being statin adherent. Targeted clinician- and patient-level interventions are needed to study and address these disparities among patients with PAD and ICVD.
本研究旨在调查外周动脉疾病（PAD）和缺血性脑血管疾病（ICVD）患者中基于性别的他汀类药物处方率和依从性差异。
我们在退伍军人事务部医疗保健系统中确定了 2013 年至 2014 年间寻求初级保健的 PAD 或 ICVD 患者。我们评估了与男性相比，女性 PAD 或 ICVD 患者使用任何他汀类药物、高强度他汀类药物（HIS）和他汀类药物依从性。我们还比较了作为他汀类药物依从性衡量标准的覆盖率（PDC）；PDC≥0.8 被视为患者他汀类药物依从性。还确定了他汀类药物使用（或依从性）与 12 个月随访时死亡或心肌梗死（MI）的几率之间的关联。
我们的分析包括 192219 名男性和 3188 名女性 PAD 患者，331352 名男性和 10490 名女性 ICVD 患者。与男性相比，患有 PAD 的女性处方任何他汀类药物的比例较低（68.5% vs. 78.7%，OR 0.68，95%置信区间（CI）0.62-0.75）、HIS（21.1% vs. 23.7%，OR 0.88，95% CI 0.79-0.97）和他汀类药物依从性较低（PDC≥0.8：34.6% vs. 45.5%，OR 0.75，95% CI 0.69-0.82）。在 ICVD 患者中也存在类似的差异。在患有 PAD 或 ICVD 的女性患者中，他汀类药物依从性与 MI 的几率较低相关（OR 0.76，95% CI 0.59-0.98），而使用任何他汀类药物（OR 0.71，95% CI 0.56-0.91）和 HIS（OR 0.68，95% CI 0.48-0.97）与 12 个月时的死亡几率较低相关。
患有 PAD 或 ICVD 的女性接受任何他汀类药物、HIS 或他汀类药物依从性的几率较低。需要针对临床医生和患者进行有针对性的干预，以研究和解决 PAD 和 ICVD 患者中的这些差异。
