ESC 2017: Women Are Less Likely Than Men to Receive Recommended Statin Doses
August 26, 2017—Barcelona, Spain—Women at high risk of cardiovascular events have been found to be less likely to receive recommended statin doses for secondary prevention.
This conclusion, based on results of the multinational cross-sectional Dyslipidaemia International Study II (DYSIS II) in Europe, Canada, South Africa, the Middle East, and China, was presented at the 2017 European Society of Cardiology (ESC) Congress, from August 26 – 30.
Anselm Kai Gitt, MD, of the Heart Centre Ludwigshafen, Germany, explained that the importance of lowering low-density lipoprotein (LDL) cholesterol is undisputed, with research demonstrating that a decrease of 1 mmoL/L (39 mg/dL) may reduce the 5-year risk of major coronary events, need for revascularization, and stroke by approximately one-fifth. Additional decreases improve outcomes even more.
Because LDL cholesterol is a major contributor to cardiovascular disease, DYSIS II set out to determine LDL cholesterol target value attainment, use of lipid-lowering therapy, and cardiovascular outcomes in patients with stable coronary heart disease and those suffering from an acute coronary syndrome.
Conclusions of DYSIS II were that attainment of LDL cholesterol targets was extremely low in patients with very high risk coronary heart disease and acute coronary syndrome, statin dosages were not maximized, with combination therapies used scarcely, and hyperlipidemia was undertreated on a global scale.
The reduction in major coronary events from lowering LDL cholesterol is reflected in European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines, which advocate pursuing LDL cholesterol treatment targets defined based on a patient's risk.
Many studies, however, have shown that in real-life practice, the rate of achieving an LDL cholesterol target of <70 mg/dL for very high risk patients in secondary prevention is only 20 – 25%.
Dr. Gitt said, “Observational trials in many fields of cardiology have shown that female patients are less likely to be treated according to current guidelines. We therefore raised the question of whether female sex exerts an impact on reaching the LDL cholesterol target of <70 mg/dL for secondary prevention in clinical practice.”
DYSIS II assessed the proportion of male and female patients who achieved treatment targets in clinical practice. Between 2008 and 2012, 57,855 consecutive outpatients treated with statins were enrolled.
Data was collected on cardiovascular risk factors, statin treatment and dose, and LDL cholesterol level. All information was obtained under real life conditions in an outpatient setting. Each patient’s risk of a cardiovascular event was calculated using the ESC Systematic COronary Risk Evaluation (SCORE) risk charts.
The researchers then examined the association between female sex and achieving an LDL cholesterol level of <70 mg/dL in patients at very high risk of a cardiovascular event.
A total of 46,310 patients in the study were at very high risk of a cardiovascular event, of whom 18,653 (40.3%) were women. Compared to men, female patients were older, more often harbored risk factors such as hypertension and diabetes, and less often suffered from manifest ischemic heart disease.
Body mass index was 27.7 ± 5.8 kg/m2 in both men and women. A total of 79.4% of women and 75.6% of men had hypertension (P < .001). A total of 55.3% of women and 47.0% of men had diabetes (P < .001).
Women were more often treated with less potent, as well as lower doses, of statins, independent of the statin used. Only 17.5% of women reached the LDL cholesterol target of <70 mg/dL vs 24% of men (P < .001).
Even after correcting for differences in baseline characteristics, female sex independently predicted failure to achieve the LDL cholesterol target in clinical practice (odds ratio 0.68; 95% confidence interval 0.47 – 0.97).
Dr. Gitt concluded, “Women at very high risk of a cardiovascular event were treated with less potent, and lower doses, of statins than men in clinical practice. Compared with men, women were at a 32% lower chance of reaching the LDL cholesterol target recommended by ESC/EAS guidelines. More research is needed to discover why women are treated inadequately to avoid preventable cardiovascular events.”
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