Abstract 11733: Gender Differences in Statin Prescriptions for Secondary Prevention in Ambulatory Settings

Abstract

Introduction: The American College of Cardiology and American Heart Association (ACC/AHA) 2013 guidelines recommend statin medications and lifestyle counselling for patients with a history of atherosclerotic cardiovascular disease (ASCVD). There is limited data regarding statin prescriptions and lifestyle counselling for secondary prevention in ambulatory settings. We aimed to examine temporal trends in primary care usage of recommended secondary prevention strategies among men and women with ASCVD in a nationally representative, ambulatory care database. Methods: The National Ambulatory Medical Care Survey (NAMCS) provides measures of ambulatory medical care services used in the United States. The study sample consisted of adults with ASCVD seen in ambulatory care clinics from 2006-2016. We analyzed the proportion of patients receiving secondary prevention strategies, statin medications or lifestyle counseling (including weight reduction, diet, and exercise) and examined differences by gender. Patient sample weights were applied to enable nationally representative estimates. Results: From 2006-2016, there were 7263 total outpatient visits (representing 179.9 million visits) for adults with a history of ASCVD. Average age was 63 (SD, 10), 37% were women. Statin prescriptions ranged from 44% (2006) to 46% (2016). Lifestyle counselling was also recommended very infrequently (16-34% range). Women were less likely than men to receive statins. For example, in 2016 men received statins 49% of the time compared with only 41 % in women. Following 2013 AHA/ACC guidelines, men had a 9% increase in statin prescriptions while for women it increased only 5%. Lifestyle counseling decreased from 25% to 23% post-2013, men decreasing by 6% and women increasing by 5%. Nutrition and exercise counseling was done only in 21% and 13% of the visits in 2016. Conclusion: Despite the ACC/AHA guidelines emphasis on statin use and lifestyle recommendations for secondary prevention in high risk ASCVD patients, the overall rates in ambulatory care remain low. Women were less likely to receive these preventive measures.