Sex-Related Disparities in Cardiovascular Health Care Among Patients With Premature Atherosclerotic Cardiovascular Disease

Abstract

IMPORTANCEThere is a paucity of data regarding secondary prevention care disparities in women with premature and extremely premature atherosclerotic cardiovascular disease (ASCVD), defined as an ASCVD event at 55 years or younger and 40 years or younger, respectively.OBJECTIVE To evaluate sex-based differences in antiplatelet agents, any statin, high-intensity statin (HIS) therapy, and statin adherence in patients with premature and extremely premature ASCVD. DESIGN, SETTING, AND PARTICIPANTSThis was a cross-sectional, multicenter, nationwide VA health care system-based study with patients enrolled in the Veterans With Premature Atherosclerosis (VITAL) registry. The study assessed patients who had at least 1 primary care visit in the Veterans Affairs (VA) health care system from October 1, 2014, to September 30, 2015. Participants included 147 600 veteran patients with premature ASCVD, encompassing ischemic heart disease (IHD), ischemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD).EXPOSURES Women vs men with premature and extremely premature ASCVD.MAIN OUTCOMES AND MEASURES Antiplatelet use, any statin use, HIS use, and statin adherence (proportion of days covered [PDC] Ն0.8). RESULTSWe identified 10 413 women and 137 187 men with premature ASCVD (age Յ55 years) and 1340 women and 8145 men with extremely premature (age Յ40 years) ASCVD. Among patients with premature and extremely premature ASCVD, women represented 7.1% and 14.1% of those groups, respectively. When compared with men, women with premature ASCVD had a higher proportion of African American patients (36.1% vs 23.8%) and lower proportions of Asian patients (0.5% vs 0.7%) and White patients (56.1% vs. 68.1%). In the extremely premature ASCVD group, women had a comparatively higher proportion of African American patients (36.8% vs 23.2%) and lower proportion of White patients (55.0% vs 67.8%) and Asian patients (1.3% vs 1.5%) than men. Among patients with premature IHD, women received less antiplatelet (adjusted odds ratio [AOR], 0.47, 95% CI, 0.45-0.50), any statin (AOR, 0.62; 95% CI, 0.59-0.66), and HIS (AOR, 0.63; 95% CI, 0.59-0.66) therapy and were less statin adherent (mean [SD] PDC, 0.68 [0.34] vs 0.73 [0.31]; β coefficient: −0.02; 95% CI, −0.03 to −0.01) compared with men. Similarly, women with premature ICVD and premature PAD received comparatively less antiplatelet agents, any statin, and HIS. Among patients with extremely premature ASCVD, women also received less antiplatelet therapy (AOR, 0.61; 95% CI, 0.53-0.70), any statin therapy (AOR, 0.51; 95% CI, 0.44-0.58), and HIS therapy (AOR, 0.45; 95% CI, 0.37-0.54) than men. There were no sex-associated differences in statin adherence among patients with premature ICVD, premature PAD, or extremely premature ASCVD. CONCLUSIONS AND RELEVANCEThis cross-sectional study revealed that women veterans with premature ASCVD and extremely premature ASCVD receive less optimal secondary prevention cardiovascular care in comparison with men. Women with premature ASCVD, particularly those...

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…In adjusted analyses, females were less likely to receive antiplatelet therapy (OR, 0.47 [95% CI, 0.45–0.50]), any statin (OR, 0.62 [95% CI, 0.59–0.66]), or high-intensity statin (OR, 0.63 [95% CI, 0.59–0.66]) than males. 114…”

Sex Differences in Peripheral Artery Disease

“…However, in a study of veteran patients with PAD, young women were also less likely to receive antiplatelet therapy than men (59% versus 78%, respectively). 185 These findings support the need for further investigation into differential use by sex of this important class of therapies proven to reduce risk of atherothrombotic events in PAD.…”

Gender Differences in Guideline-Directed Medical Therapy for Cardiovascular Disease Among Young Veterans

“…A recent VA study found similar gender-based disparities in the use of antiplatelet medications and statins among women with premature atherosclerotic CVD compared to men. 16 Our study underscores the critical need to understand reasons for the relative undertreatment of women with guideline-concordant care.…”

“…15 Although prior research has examined risk factors, only one study has examined possible disparities by gender in established CVD. 16 Furthermore, no research has examined if there are gender differences in medical therapy for HF among Veterans. Given the increasing burden of CVD in women Veterans and limited data on guideline-directed medical therapy (GDMT) in this high-risk population, we sought to determine if there are gender differences in the provision of outpatient GDMT for CAD and HF.…”