Gender Disparities in Rejection of Statin Therapy and Delays in Achievement of LDL Control among Patients at High Cardiovascular Risk

Many patients at high cardiovascular risk do not receive statin therapy, proven to reduce this risk. Lack of statin therapy is particularly common among women. The reasons for this are not well understood. We therefore conducted a study to determine whether rejection of statin therapy contributed to gender disparities in statin therapy and LDL control.

We retrospectively analyzed EHR records of patients with ASCVD, diabetes or LDL ≥ 190 mg/dL treated between 2000 and 2018. Natural language processing – an artificial intelligence technology for text analysis – was used to identify patients reported to have rejected statin therapy when it was first recommended.

Out of 24,212 study patients, 12,294 (50.8%) were women; 8,759 had CAD; 3,582 had CVA; 3,386 had PVD; 11,999 had diabetes; and 7,556 had h/o LDL > 190. Of these, 5,308 (21.9%) initially declined statin therapy, including 2,957 (24.0%) women. Women rejected statin therapy more commonly than men in each (CAD, CVA, etc.) ASCVD risk group. In multivariable analysis adjusted for demographics, comorbidities and baseline LDL, women had OR of 1.23 (95% CI 1.17-1.31) for rejecting statin therapy. Patients who accepted vs. rejected initial statin therapy recommendation reached LDL < 100 mg/dL after a median of 78 vs. 227 weeks (P < 0.0001). In multivariable analysis, women had HR of 0.82 (95% CI 0.79 – 0.84) for time to LDL < 100.

Initial rejection of statin therapy was common among patients at high cardiovascular risk and was strongly associated with significant delays in LDL control. Women were more likely to reject statin therapy and had longer time to LDL control. Further research is needed to understand the reasons for gender disparities in statin therapy rejection and to develop more effective approaches to statin therapy recommendations for both women and men.