Abstract
Introduction: Statin therapy has been shown to reduce ASCVD morbidity and mortality. Evidence on statin utilization per the ACC/AHA cholesterol guidelines and outcomes are limited in primary prevention cohorts of women. We investigated statin use outcomes per 10-year ASCVD risk in a large healthcare system stratified by sex. Methods: Statin prescription in patients without CAD (MI or revascularization) or ischemic stroke were evaluated (2013-2019). Risk categories per the ASCVD risk were defined as: Borderline (5%-7.4%), Intermediate (7.5%-19.9%) or High (≥20%). Guideline-directed statin intensity (GDSI), at time of first event, was defined as: “at least moderate” for Intermediate and high -risk groups. Cox regression hazard ratios (HR) [95% CI] were calculated for statin use and outcomes (MI, stroke and composite ASCVD events) stratified by gender. Interaction terms (age ≥75y and sex) were applied. Results: Among 159,100 women (out of 282,298 patients; mean age ~51y), 15,153 (9.5%), 26,697 (16.8%) and 10,583 (6.7%) were categorized as borderline, intermediate and high risk, respectively. Only 9,277 (35%) intermediate and 4,893 (46%) of high-risk women received any intensity of statin. High risk women (vs men) on GDSI, had lower association with CAD events (HR 0.8 [0.7-0.9]) and increased stroke risk (HR 1.2 [1.1-1.4]) ( Table). Intermediate and high-risk women (on <GD statin or no statin) had higher stroke risk than those on GD statin (p for interaction <0.001 ). Older women (≥75y) on “no statin” (vs GD statin) had independently increased risk of CAD (HR 1.30[1.1-1.6]) (p interaction <0.001) . Conclusions: In a real-world primary prevention cohort, women on statin therapy had significantly improved ASCVD outcomes and lower mortality. However, approximately one-fourth of statin-eligible women were not prescribed any statin therapy. Further research can develop healthcare system strategies to optimize under-treatment of women for ASCVD prevention.
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