Sex Differences in the Use of Statins in Community Practice: Patient and Provider Assessment of Lipid Management Registry
Open accessAbstract
Background: Female patients have historically received less aggressive lipid management than male patients. Contemporary care patterns and the potential causes for these differences are unknown. Methods and Results: Examining the Patient and Provider Assessment of Lipid Management Registry—a nationwide registry of outpatients with or at risk for atherosclerotic cardiovascular disease—we compared the use of statin therapy, guideline-recommended statin dosing, and reasons for undertreatment. We specifically analyzed sex differences in statin treatment and guideline-recommended statin dosing using multivariable logistic regression. Among 5693 participants (43% women) eligible for 2013 American College of Cardiology/American Heart Association Cholesterol Guideline–recommended statin treatment, women were less likely than men to be prescribed any statin therapy (67.0% versus 78.4%; P <0.001) or to receive a statin at the guideline-recommended intensity (36.7% versus 45.2%; P <0.001). Women were more likely to report having previously never been offered statin therapy (18.6% versus 13.5%; P <0.001), declined statin therapy (3.6% versus 2.0%; P <0.001), or discontinued their statin (10.9% versus 6.1%; P <0.001). Women were also less likely than men to believe statins were safe (47.9% versus 55.2%; P <0.001) or effective (68.0% versus 73.2%; P <0.001) and more likely to report discontinuing their statin because of a side effect (7.9% versus 3.6%; P <0.001). Sex differences in both overall and guideline-recommended intensity statin use persisted after adjustment for demographics, socioeconomic factors, clinical characteristics, patient beliefs, and provider characteristics (adjusted odds ratio, 0.70; 95% CI, 0.61–0.81; P <0.001; and odds ratio, 0.82; 95% CI, 0.73–0.92; P <0.01, respectively). Sex differences were consistent across primary and secondary prevention indications for statin treatment. Conclusions: Women eligible for statin therapy were less likely than men to be treated with any statin or guideline-recommended statin intensity. A combination of women being offered statin therapy less frequently, while declining and discontinuing treatment more frequently, accounted for these sex differences in statin use.
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Individuals of childbearing potential are less likely to be treated with statins or achieve their LDL cholesterol goals based on their cardiovascular risk.
“Individuals of childbearing potential are less likely to be treated with statins or achieve their LDL cholesterol goals based on their cardiovascular risk (144-146).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [146]
The Results (Statin Use and Dosing Intensity; page not provided) show that females eligible for statins were less likely than males to receive a statin or guideline-recommended intensity. The paper does not establish this specifically for individuals of childbearing potential, and its treatment-intensity finding does not show whether patients achieved LDL-cholesterol goals based on cardiovascular risk. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIndividuals of childbearing potential are less likely to be treated with statins or achieve their LDL cholesterol goals based on their cardiovascular risk.
“Individuals of childbearing potential are less likely to be treated with statins or achieve their LDL cholesterol goals based on their cardiovascular risk (138–140).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [140]
The Results (Statin Use and Dosing Intensity; page not provided) show that statin-eligible females were less likely than males to receive a statin or guideline-recommended intensity. The paper does not establish this specifically for individuals of childbearing potential or report whether they achieved LDL-cholesterol goals. (LLM, conf=0.88)
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- Authors
- Nanna, M. G., Wang, T. Y., Xiang, Q., Goldberg, A. C., Robinson, J. G., Roger, V. L., Virani, S. S., Wilson, P. W. F., Louie, M. J., Koren, A., Li, Z., Peterson, E. D., & Navar, A. M.
- Affiliations
- Duke University (US)
- Washington University in St. Louis (US)
- University of Iowa (US)
- Mayo Clinic (US)
- Baylor College of Medicine (US)
- Atlanta VA Medical Center (US)
- Regeneron (United States) (US)
- Sanofi (United States) (US)
- Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., T.Y.W., Q.X., Z.L., E.D.P., A.M.N.).
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2019-08
- Volume
- 12
- Issue
- 8
- Pages
- e005562-e005562
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- PMC
- PMC6903404
- OpenAlex
- W2968097947
- Cited by
- 313
- References
- 21
- Citations by year
- 2026: 45 · 2025: 51 · 2024: 62 · 2023: 57 · 2022: 50 · 2021: 27 · 2020: 17 · 2019: 3
- FWCI
- 23.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs
- American Heart Association
- Sanofi
- Regeneron Pharmaceuticals
- National Institutes of Health (5t32hl069749-20)
- National Heart, Lung, and Blood Institute (T32-HL069749, K01HL133416)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Keywords
- sex differences, lipid control, undertreatment, atherosclerotic cardiovascular disease, statin adverse effects, primary and secondary prevention, cholesterol guidelines, patient-provider communication, drug discontinuation, socioeconomic disparities
- MeSH terms
- Aged, Cardiovascular Diseases, Community Health Services, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Practice Patterns, Physicians', Primary Prevention, Registries, Risk Factors, Sex Factors, Time Factors, United States, Treatment Refusal, Treatment Outcome, Practice Guidelines as Topic, Risk Assessment, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Guideline Adherence, Dyslipidemias, Healthcare Disparities, Medication Adherence, Secondary Prevention
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