We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Assessment of Sex Disparities in Nonacceptance of Statin Therapy and Low-Density Lipoprotein Cholesterol Levels Among Patients at High Cardiovascular Risk.
- Authors
Brown, C. Justin; Chang, Lee-Shing; Hosomura, Naoshi; Malmasi, Shervin; Morrison, Fritha; Shubina, Maria; Lan, Zhou; Turchin, Alexander
- Abstract
Key Points: Question: How are sex disparities in nonacceptance of statin therapy associated with control of low-density lipoprotein (LDL) cholesterol levels? Findings: In this cohort study of 24 212 adults at high cardiovascular risk, patients who accepted a statin therapy recommendation by their clinicians achieved an LDL cholesterol level of less than 100 mg/dL in a median time of 1.5 years vs 4.4 years for patients who did not accept statin therapy. Women were significantly less likely than men to accept statin therapy recommendations and achieve an LDL cholesterol level of less than 100 mg/dL. Meaning: This study suggests that patients who do not accept statin therapy have significantly higher LDL cholesterol levels; sex disparities in statin acceptance could be associated with cardiovascular risk for women. Importance: Many patients at high cardiovascular risk—women more commonly than men—are not receiving statins. Anecdotally, it is common for patients to not accept statin therapy recommendations by their clinicians. However, population-based data on nonacceptance of statin therapy by patients are lacking. Objectives: To evaluate sex disparities in nonacceptance of statin therapy and assess their association with low-density lipoprotein (LDL) cholesterol control. Design, Setting, and Participants: A retrospective cohort study was conducted from January 1, 2019, to December 31, 2022, of statin-naive patients with atherosclerotic cardiovascular disease, diabetes, or LDL cholesterol levels of 190 mg/dL (to convert to millimoles per liter, multiply by 0.0259) or more who were treated at Mass General Brigham between January 1, 2000, and December 31, 2018. Exposure: Recommendation of statin therapy by the patient's clinician, ascertained from the combination of electronic health record prescription data and natural language processing of electronic clinician notes. Main Outcomes and Measures: Time to achieve an LDL cholesterol level of less than 100 mg/dL. Results: Of 24 212 study patients (mean [SD] age, 58.8 [13.0] years; 12 294 women [50.8%]), 5308 (21.9%) did not accept the initial recommendation of statin therapy. Nonacceptance of statin therapy was more common among women than men (24.1% [2957 of 12 294] vs 19.7% [2351 of 11 918]; P <.001) and was similarly higher in every subgroup in the analysis stratified by comorbidities. In multivariable analysis, female sex was associated with lower odds of statin therapy acceptance (0.82 [95% CI, 0.78-0.88]). Patients who did vs did not accept a statin therapy recommendation achieved an LDL cholesterol level of less than 100 mg/dL over a median of 1.5 years (IQR, 0.4-5.5 years) vs 4.4 years (IQR, 1.3-11.1 years) (P <.001). In a multivariable analysis adjusted for demographic characteristics and comorbidities, nonacceptance of statin therapy was associated with a longer time to achieve an LDL cholesterol level of less than 100 mg/dL (hazard ratio, 0.57 [95% CI, 0.55-0.60]). Conclusions and Relevance: This cohort study suggests that nonacceptance of a statin therapy recommendation was common among patients at high cardiovascular risk and was particularly common among women. It was associated with significantly higher LDL cholesterol levels, potentially increasing the risk for cardiovascular events. Further research is needed to understand the reasons for nonacceptance of statin therapy by patients and to develop methods to ensure that all patients receive optimal therapy in accordance with their preferences and priorities. This cohort study assesses sex disparities in nonacceptance of statin therapy and assess their association with low-density lipoprotein (LDL) cholesterol control.
- Subjects
STATINS (Cardiovascular agents); CARDIOVASCULAR diseases risk factors; THERAPEUTICS; CONFIDENCE intervals; ATTITUDE (Psychology); NATURAL language processing; LOG-rank test; LDL cholesterol; RETROSPECTIVE studies; SEX distribution; PATIENTS' attitudes; ATHEROSCLEROSIS; T-test (Statistics); DRUGS; DESCRIPTIVE statistics; CHI-squared test; RESEARCH funding; HEALTH equity; PATIENT compliance; ELECTRONIC health records; ODDS ratio; DATA analysis software; LOGISTIC regression analysis; LONGITUDINAL method; COMORBIDITY; PROPORTIONAL hazards models; SECONDARY analysis
- Publication
JAMA Network Open, 2023, Vol 6, Issue 2, pe231047
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.1047