Author + information
- Received October 27, 2017
- Revision received January 16, 2018
- Accepted February 7, 2018
- Published online April 16, 2018.
- Sanne A.E. Peters, PhDa,∗ (, )
- Lisandro D. Colantonio, MD, PhDb,
- Hong Zhao, PhDb,
- Vera Bittner, MDc,
- Yuling Dai, MSPHb,
- Michael E. Farkouh, MD, MScd,
- Keri L. Monda, PhDe,
- Monika M. Safford, MDf,
- Paul Muntner, PhDb and
- Mark Woodward, PhDa,g,h
- aThe George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- bDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- cDivision of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- dPeter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
- eCenter for Observational Research, Amgen, Thousand Oaks, California
- fDivision of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
- gThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- hDepartment of Epidemiology, Johns Hopkins University, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Sanne A.E. Peters, The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, United Kingdom.
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.
The work for this manuscript was funded by an industry/academic collaboration between Amgen Inc. and University of Alabama at Birmingham. Dr. Peters is supported by a U.K. Medical Research Council Skills Development Fellowship (MR/P014550/1). Dr. Bittner has received grant support from Amgen (coinvestigator on a contract between University of Alabama at Birmingham [UAB] School of Public Health and Amgen), AstraZeneca (UAB site principal investigator for ARTEMIS study; contracted through the university to serve as national coordinator for the STRENGTH trial), Bayer Healthcare (site principal investigator for COMPASS trial), Dalcor (contracted through UAB as National Coordinator for the DalGene Trial), Eli Lilly, Esperion (contracted through UAB as National Coordinator for the CLEAR trial), and Sanofi/Regeneron (contracted through the university to serve on the Steering Committee for Odyssey Outcomes Trial; attended advisory board at AHA 2017). Dr. Farkouh has received grant support from Amgen, Inc. Dr. Monda is an employee and stockholder of Amgen, Inc. Dr. Safford has received grant support from Amgen. Dr. Muntner has received grant support and honoraria from Amgen, Inc. Dr. Woodward has received consulting fees from Amgen, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Nanette K. Wenger, MD, served as Guest Editor for this paper.
- Received October 27, 2017.
- Revision received January 16, 2018.
- Accepted February 7, 2018.
- 2018 American College of Cardiology Foundation