Abstract
Background: High intensity statins have been shown to lower the risk of major cardiovascular events after an index myocardial infarction (MI). Studies have shown that women are less likely than men to receive cardiovascular risk reduction therapies but little is known about sex differences in high intensity statin use following hospital discharge for MI. Methods: We compared high intensity statin use following hospital discharge for MI in 2014 between men and women 19 to 64 years with commercial health insurance in the Marketscan database (n=7,089 men and 2,318 women) and Medicare beneficiaries ≥66 years (n=20,202 men and n=18,937 women). Patients were included if they filled a statin of any intensity within 30 days following hospital discharge. Statin fills were identified through pharmacy claims and high intensity statins included atorvastatin 40 or 80 mg and rosuvastatin 20 or 40 mg. Results: Among patients not taking statins prior to having an MI (n=6,303 in Marketscan and n=17,763 in Medicare), 69.4% of men and 62.4% of women (p-value <0.001) in the Marketscan database and 55.2% of men and 48.1% of women (p-value <0.001) with health insurance through Medicare initiated treatment with a high intensity statin. Among patients taking low or moderate intensity statins prior to having an MI (n=2,234 in Marketscan and n=16,818 in Medicare), 58.0% of men and 49.2% of women (p-value <0.001) in the Marketscan database and 38.2% of men and 31.7% of women (p-value <0.001) in Medicare titrated to a high intensity statin within 30 days of hospital discharge. After multivariable adjustment, women were less likely to initiate treatment with a high intensity statin (relative risk: 0.92; 95% CI 0.88-0.96 in Marketscan and 0.92; 95% CI 0.90-0.95 in Medicare) or titrate from low/moderate to high intensity statin (relative risk: 0.89 95% CI 0.81-0.95 in Marketscan and 0.89; 95% CI 0.86-0.93 in Medicare). Among those taking a high intensity statin prior to their MI (n=870 in Marketscan and n=4,558 in Medicare), 92.0% and 87.4% of men and women, respectively, in Marketscan (adjusted relative risk 0.95; 95% CI 0.90-1.01) and 91.5% and 88.1% of men and women, respectively, in Medicare (adjusted relative risk 0.97; 95% CI 0.95-0.99), remained on a high intensity statin following hospital discharge. Conclusions: Women are less likely than men to receive high intensity statins following hospital discharge for MI.
Published Version
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