Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Heart. 2024 Jul 10;110(15):981-987. doi: 10.1136/heartjnl-2023-323722.
Current guidelines for the prevention and management of cardiovascular diseases (CVD) provide similar recommendations for the use of statins in both women and men. In this study, we assessed sex differences in the intensity of statin prescriptions at initiation and in the achievement of treatment targets, among individuals without and with CVD, in a primary care setting.
Electronic health record data from statin users were extracted from the PHARMO Data Network. Poisson regressions were used to investigate sex differences in statin intensity and in the achievement of treatment targets. Analyses were stratified by age group, disease status and/or CVD risk category.
We included 82 714 individuals (46% women) aged 40-99 years old. In both sexes, the proportion of individuals with a dispensed prescription for high-intensity statin at initiation increased between 2011 and 2020. Women were less likely to be prescribed high-intensity statins as compared with men, both in the subgroups without a history of CVD (risk ratio (RR) 0.69 (95% CI: 0.63 to 0.75)) and with CVD (RR 0.77 (95% CI: 0.74 to 0.81)). Women were less likely than men to achieve target levels of low-density lipoprotein cholesterol following statin initiation in the subgroup without CVD (RR 0.98 (95% CI: 0.97 to 1.00)) and with a history of CVD (RR 0.94 (95% CI: 0.89 to 0.98)).
Compared with men, women were less likely to be prescribed high-intensity statins at initiation and to achieve treatment targets, both in people without and with a history of CVD, and independent of differences in other individual and clinical characteristics.
目前的心血管疾病（CVD）预防和管理指南为女性和男性使用他汀类药物提供了类似的建议。在这项研究中，我们评估了在初级保健环境中，无 CVD 和有 CVD 的个体在开始使用他汀类药物时的他汀类药物强度和治疗目标达标情况方面的性别差异。
从 PHARMO 数据网络中提取使用他汀类药物患者的电子健康记录数据。使用泊松回归来研究他汀类药物强度和治疗目标达标方面的性别差异。分析按年龄组、疾病状态和/或 CVD 风险类别进行分层。
我们纳入了 82714 名年龄在 40-99 岁的个体（46%为女性）。在男性和女性中，从 2011 年到 2020 年，开始使用高剂量他汀类药物的个体中，开具高剂量他汀类药物处方的比例有所增加。与男性相比，女性开具高剂量他汀类药物的可能性较低，无论在无 CVD 病史的亚组（风险比（RR）0.69（95%可信区间：0.63 至 0.75））还是有 CVD 病史的亚组（RR 0.77（95%可信区间：0.74 至 0.81））。与男性相比，无 CVD 病史的亚组（RR 0.98（95%可信区间：0.97 至 1.00））和有 CVD 病史的亚组（RR 0.94（95%可信区间：0.89 至 0.98）），女性在开始使用他汀类药物后实现低密度脂蛋白胆固醇治疗目标的可能性也较低。
与男性相比，无论是否有 CVD 病史，女性在开始使用他汀类药物时开具高强度他汀类药物的可能性较低，并且达到治疗目标的可能性也较低，而且与其他个体和临床特征的差异无关。
