Abstract 307: Gender Differences in Recurrent Cardiovascular Events Among High-risk Patients With Hyperlipidemia

Abstract

Background: Hyperlipidemia is associated with increased risk of cardiovascular (CV) events, especially among adults with a history of cardiovascular disease (CVD). It is unclear whether the increased risk is similar between men and women. Purpose: This study evaluated the occurrence of subsequent cardiovascular events among high-risk patients with hyperlipidemia and a history of prior CV events who were enrolled in US health plans, stratified by gender. Methods: Patients (age 18-64) with a hyperlipidemia diagnosis or using lipid-lowering therapy (LLT) from 1/1/2007 to 12/31/2008, and a history of ≥ 1 CV events (myocardial infarction [MI], ischemic stroke [IS], unstable angina [UA], coronary artery bypass graft (CABG) or percutaneous coronary intervention [PCI]) in the 12 months prior to hyperlipidemia diagnosis or LLT use were selected from the large payer claims database (HealthCore Integrated Research Database SM ). Patientswere followed until the end of study period (02/28/2013) or end of health plan eligibility or death (whichever occurred first). Incidence and time to subsequent CV events were calculated. Results: In the CV event history cohort (n=9890, mean age=55 years), 67% were men and 33% were women. A significantly greater proportion of women (44.6%) had ≥1 subsequent CV event compared with men (40.5%, p<0.0001), and women also had a greater proportion of ≥3 subsequent CV events (21.0% women vs. 17.8% men, p<0.0001). In patients with subsequent events, mean (SD) time to first subsequent CV event was significantly shorter for women [741 (541) days] than for men [810 (570) days], p<0.0001. This pattern of more recurrent CV events and shorter time to first subsequent CV event among women was observed for MI, UA, PCI, and heart failure (e.g. 48.3% of women and 37.7% of men had ≥1 MI, p<0.001 and time to first event was 836 (571) days for women versus 971 (599) days for men, p=0.001). There were no differences between women and men for stroke or TIA. Mean (SD) inpatient costs for patients with subsequent CV events did not differ by gender (e.g. for MI, $37,804 (104,478) for women versus $39,705 (81,914) for men, p=0.77). Conclusions: Among high-risk patients (i.e. history of CV events) enrolled in US health plans, women were more likely to have a subsequent CV event and multiple CV events sooner than men. Further research is needed to ascertain whether the gender differences might reflect differences in the intensity of treatment for hyperlipidemia between men and women.