Abstract 13522: Gender Disparities in Low Density Lipoprotein Cholesterol Management Across the Spectrum of Atherosclerotic Cardiovascular Diseases: Insights From the Houston Methodist Cardiovascular Disease Learning Health System Registry

Abstract

Introduction: Statin utilization for LDL-C lowering remains the cornerstone management strategy to reduce the risk of ASCVD. While lower statin utilization has been reported among women compared to men, contemporary studies evaluating sex disparities in LDL-C management across the spectrum of ASCVD are lacking, particularly across age and racial/ethnic subgroups. We aimed to provide detailed insights into this using data from a large US healthcare system. Methods: Cross-sectional study using data from ∼1.1 million patients aged 18+ years in the Houston Methodist Learning Health System Registry (2016-2022). Prevalent ASCVD including CAD, PAD, and stroke were identified using ICD 10-CM codes. Statin use and dose were identified in the database using ATC codes, and this information was recorded based on medication reconciliation reviews with patients at each clinical encounter. Individuals (n=973,720) without established ASCVD were excluded. Results: The study population consisted of 97,819 patients with prevalent ASCVD (55% men; 45% women, mean age: 69 years, 19% NHB, 12% Hispanic). Women with ASCVD reported lower statin use (64.3% vs 72.6%) and lower high-intensity statin use (29.8% vs 42.5%) compared with men. Women were also less likely to have on-treatment LDL-C <70, and this was true for total ASCVD (21.8% vs 30.6%), CAD (24.9% vs 32.9%), PAD (23.2% vs 32.6%), and stroke (20.9% vs 30.1%). These disparities persisted across age (<45, 45-64, >65 years) and racial/ethnic (NHW, Hispanics, NHB, Asian/Other) strata. Conclusion: Significant gender disparities exist in contemporary LDL-C management among US patients with ASCVD, with women being less likely to receive any and high-intensity statin therapy, and reach the guideline defined goal of LDL-C <70 mg/dL than men across age and racial/ethnic subgroups. These disparities underscore the need for further research to understand their drivers, and targeted systemwide programs to overcome care gaps.