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Cardiac risk factors and prevention
Original research
Sex differences in the intensity of statin prescriptions at initiation in a primary care setting
  1. Pauline A J Kiss1,
  2. Alicia Uijl1,2,3,
  3. Annemarijn R de Boer1,
  4. Tessa C X Duk1,
  5. Diederick E Grobbee1,
  6. Monika Hollander1,
  7. Elisabeth Smits4,
  8. Miriam C J M Sturkenboom1,
  9. Sanne A E Peters1,5,6
  1. 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
  3. 3Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4PHARMO Institute, Utrecht, The Netherlands
  5. 5The George Institute for Global Health UK, London, UK
  6. 6The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to MSc Pauline A J Kiss, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands; p.a.j.kiss{at}umcutrecht.nl

Abstract

Background Current guidelines for the prevention and management of cardiovascular diseases (CVD) provide similar recommendations for the use of statins in both women and men. In this study, we assessed sex differences in the intensity of statin prescriptions at initiation and in the achievement of treatment targets, among individuals without and with CVD, in a primary care setting.

Methods Electronic health record data from statin users were extracted from the PHARMO Data Network. Poisson regressions were used to investigate sex differences in statin intensity and in the achievement of treatment targets. Analyses were stratified by age group, disease status and/or CVD risk category.

Results We included 82 714 individuals (46% women) aged 40–99 years old. In both sexes, the proportion of individuals with a dispensed prescription for high-intensity statin at initiation increased between 2011 and 2020. Women were less likely to be prescribed high-intensity statins as compared with men, both in the subgroups without a history of CVD (risk ratio (RR) 0.69 (95% CI: 0.63 to 0.75)) and with CVD (RR 0.77 (95% CI: 0.74 to 0.81)). Women were less likely than men to achieve target levels of low-density lipoprotein cholesterol following statin initiation in the subgroup without CVD (RR 0.98 (95% CI: 0.97 to 1.00)) and with a history of CVD (RR 0.94 (95% CI: 0.89 to 0.98)).

Conclusion Compared with men, women were less likely to be prescribed high-intensity statins at initiation and to achieve treatment targets, both in people without and with a history of CVD, and independent of differences in other individual and clinical characteristics.

  • PRIMARY CARE
  • Electronic Health Records
  • Epidemiology
  • Hyperlipidemias

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request at the PHARMO Institute.

https://doi.org/10.1136/heartjnl-2023-323722

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request at the PHARMO Institute.

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    Footnotes

    • Contributors PAJK, AU and SAEP were involved in the design and implementation of the study. PAJK conducted the analyses and drafted the manuscript. AU, SAEP, ARdB, TCXD, DEG, MH, ES and MCJMS critically revised the manuscript. SAEP was the guarantor of the study. All authors contributed to the article and approved the submitted version.

    • Funding This work was supported by a VIDI fellowship awarded to SAEP by the Dutch Organisation for Health Research and Development (ZonMW) (09150172010050).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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