Statin Prescription Rates, Adherence, and Associated Clinical Outcomes Among Women with PAD and ICVD
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ORIGINA ARTICLE
Statin Prescription Rates, Adherence, and Associated Clinical Outcomes Among Women with PAD and ICVD Dhruv Mahtta 1,2 & Sarah T. Ahmed 1 & David J. Ramsey 1 & Julia M. Akeroyd 1 & Michelle T. Lee 3 & Fatima Rodriguez 4 & Erin D. Michos 5,6 & Dipti Itchhaporia 7 & Khurram Nasir 8 & Mahboob Alam 9 & Hani Jneid 9 & Christie M. Ballantyne 2,9 & Laura A. Petersen 1,10 & Salim S. Virani 1,2,11 Accepted: 17 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose This study sought to investigate gender-based disparities in statin prescription rates and adherence among patients with peripheral arterial disease (PAD) and ischemic cerebrovascular disease (ICVD). Methods We identified patients with PAD or ICVD seeking primary care between 2013 and 2014 in the VA healthcare system. We assessed any statin use, high-intensity statin (HIS) use, and statin adherence among women with PAD or ICVD compared with men. We also compared proportion of days covered (PDC) as a measure of statin adherence; PDC ≥ 0.8 deemed a patient statin adherent. Association between statin use (or adherence) and odds of death or myocardial infarction (MI) at 12-month follow-up was also ascertained. Results Our analyses included 192,219 males and 3188 females with PAD and 331,352 males and 10,490 females with ICVD. Women with PAD had lower prescription rates of any statin (68.5% vs. 78.7%, OR 0.68, 95% confidence interval (CI) 0.62– 0.75), HIS (21.1% vs. 23.7%, OR 0.88, 95% CI 0.79–0.97), and lower statin adherence (PDC ≥ 0.8: 34.6% vs. 45.5%, OR 0.75, 95% CI 0.69–0.82) compared with men. Similar disparities were seen in ICVD patients. Among female patients with PAD or ICVD, statin adherence was associated with lower odds of MI (OR 0.76, 95% CI 0.59–0.98), while use of any statin (OR 0.71, 95% CI 0.56–0.91) and HIS (OR 0.68, 95% CI 0.48–0.97) was associated with lower odds of death at 12 months. Conclusions Women with PAD or ICVD had lower odds of receiving any statins, HIS, or being statin adherent. Targeted clinician- and patient-level interventions are needed to study and address these disparities among patients with PAD and ICVD. Key words Adherence . Gender disparities . ICVD . PAD . Prescription rates . Statin
* Salim S. Virani [email protected] 1
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Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Department of Medicine, University of Texas Health Science Center, Houston, TX, USA Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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Department of Medicine (Cardiology), Johns Hopkins School of Medicine, Baltimore, MD, USA
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Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Department of Medicine, Cardiology
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