November 11, 2018 – A DCRI analysis of patient data from the PALM Registry examines possible reasons for the treatment gap.
While the safety and efficacy of statin therapy for the prevention of atherosclerotic cardiovascular disease is well-established, female patients have historically received less aggressive lipid management than males, according to the DCRI’s Michael Nanna, MD. The reasons for those differences, he said, have been poorly understood.
To investigate this discrepancy, Nanna and his colleagues examined patient data from the PALM (Patient and Provider Assessment of Lipid Management) Registry. Their findings were presented Saturday at the American Heart Association annual meeting in Chicago.
“In looking at why statins are underutilized in eligible women,” Nanna said, “we concluded that they were more likely to never be offered a statin, to decline a statin, and to discontinue a statin than men, even when meeting a treatment indication. This was also after adjusting for patient beliefs, demographics, provider type, and other factors.”
The investigators identified nearly 6,000 adult patients (43 percent female) potentially eligible for primary or secondary prevention statins at 138 U.S. cardiology, primary care, and endocrinology practices in 2015 in the PALM Registry. PALM data and patient surveys showed that 36.7 percent of female patients were on statin treatment and guideline-recommended statin intensity compared to 45.2 percent of male patients, and that these results were consistent across levels of education and income as well as type of treating physician.
Nanna’s study used the 2013 American College of Cardiology and the American Heart Association guidelines on the treatment of blood cholesterol to identify patients eligible for guideline-recommended statin treatment.
“I was surprised to find that such differences persist in contemporary practice and the degree to which they do so,” Nanna said. “Another surprising insight was the difference in beliefs and perception between female and male patients — women were more worried about heart attacks and strokes, for example, but less likely to believe in the association between cholesterol and their heart attack risk.”
Nanna’s study also showed that about 50 percent of female and 43 percent of male patients currently on statins reported adverse effects associated with statin use and that nearly 7.8 percent of women versus 3.6 percent of men reported stopping their statin use as a result. In addition, female patients who were formerly on statins and those that were never on statins were both less willing to try a statin compared with males.
The study had several limitations, according to Nanna. The researchers were unable to specifically capture reasoning for statin prescribing and did not have access to longitudinal data on statin dosing.
“We feel that we can begin to close this treatment gap through better education and communication, especially from clinicians,” he said. “Statins are an important medication for cardiovascular risk reduction, especially for those with existing cardiovascular disease.”
In addition to Nanna, DCRI researchers contributing to the study included Tracy Wang, Qun Xiang, Eric Peterson, and Ann Marie Navar. The study was funded by a National Institutes of Health (NIH) training grant and by Sanofi and Regeneron Pharmaceuticals.