Despite efforts to implement current evidence-based practice guidelines from the American College of Cardiology/American Heart Association, a disparity still exists between men and women regarding filling high-intensity statin prescriptions following a myocardial infarction (MI).
According to a study in the Journal of American College of Cardiology, women are less likely to fill prescriptions for high-intensity statins approximately 30 days after hospitalization for an acute MI, possibly driven by erroneous medical knowledge, previous statin intolerance, or the suboptimal outcomes of treatment in female patients with an MI.
Investigators retrospectively collected and analyzed patient data from MarketScan and Medicare databases, focusing specifically on patients who filled statin prescriptions within a 30-day period following hospital discharge for an MI.
Data from 16,898 US patients age <65 with commercial health insurance and 71,358 US patients age ≥66 with government health insurance were extracted from the MarketScan and Medicare databases, respectively. Statin prescriptions filled in the cohort included atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin, with high-intensity statins of either 40 or 80 mg atorvastatin or 20 or 40 mg rosuvastatin.
Between 2007 and 2015, the percentage of beneficiaries with no prior statin use who filled prescriptions for high-intensity statins rose from 22% to 50% in women vs 27% to 64% in men. In individuals with prior low/moderate-intensity statin use, prescription filling increased from 10% to 33% in women and 14% to 42% in men during the same period. In patients with prior high-intensity statin use, the percentage of women filling prescriptions rose from 81% to 91% vs 81 to 93% in men.
Overall, the rate of high-intensity statin prescriptions filled within 30 days after a hospitalization for MI was lower in women compared with men (46.5% vs 56.4%, respectively; adjusted risk ratio [aRR], 0.91; 95% CI, 0.90-0.92). In addition, the rate of filled high-statin prescriptions was lower in women with no prior statin use history vs men with no statin use history (50.4% vs 60.7%, respectively; aRR 0.91; 95% CI, 0.89-0.92).
Slightly lower rates of high-statin prescriptions filled were also observed in women with prior low/moderate-intensity statin use vs men with the same medical history (30.2% vs 38.9%, respectively; aRR 0.87; 95% CI 0.85-0.90). Lower prescription fill rates were also observed in women with prior high-intensity statin use and high-intensity statin fill vs men (89.6% vs 91.8%, respectively; aRR 0.98; 95% CI 0.97-1.00).
Investigators restricted this analysis to data from 2014 to 2015, which may not have been enough time for centers to adopt and fully implement evidence-based guidelines. In addition, pharmacy claims are only based on prescriptions filled, not prescriptions written or medication taken.
“Increased awareness of the benefits of high-intensity statins is needed to reinforce the use of high-intensity statins among women with a prior MI,” the researchers concluded.
Peters SAE, Colantonio DC, Zhao H, et al. Sex differences in high-intensity statin use following myocardial infarction in the United States. J Am Coll Cardiol. 2018;71(16):1729-1737.