Nonacceptance of recommended statin therapy is associated with significantly higher low-density lipoprotein cholesterol (LDL-C) levels and occurs more frequently among patients at increased cardiovascular risk, particularly women. These study findings were published in JAMA Network Open.
Researchers conducted a single-center retrospective study between January 2019 and December 2022 that assessed the relationship between sex disparities and LDL-C control among patients who did not accept recommended statin therapy. Included patients were statin-naive adults at increased cardiovascular risk. The primary exposure was clinician-recommended statin therapy, and the primary outcome was time to LDL-C control (>100 mg/dL). Associations between acceptance vs nonacceptance of recommended statin therapy and time to LDL-C control were determined via marginal Cox proportional hazard regression models.
Among 24,212 patients included in the analysis, the mean (SD) age was 58.8 (13.0) years, 50.8% were women, the median LDL-C level at baseline was 137 mg/dL 48.2% had atherosclerotic cardiovascular disease. The remaining patients had either diabetes or severe hypercholesterolemia.
A total of 5308 (21.9%) patients did not initially accept recommended statin therapy, with 1457 (6.0%) never initiating therapy during the follow-up period. Both nonacceptance of initial statin therapy recommendations and lack of initiation throughout the follow-up period were significantly more common among women vs men (both P <.001). Similar findings were observed after patients were stratified by comorbidities.
During a mean (SD) follow-up period of 7.9 (4.5) years, 77.6% of patients achieved an LDL-C level of less than 100 mg/dL after a median time of 1.9 (IQR, 0.5-6.8) years. Further analysis showed that median time to LDL-C control was 1.5 (IQR, 0.4-5.5) and 4.4 (IQR, 1.3-11.1) years among patients who did vs did not accept recommended statin therapy, respectively (P <.001).
After adjustments for patient demographics and comorbidities, nonacceptance of recommended statin therapy (hazard ratio [HR], 0.57; 95% CI, 0.55-0.60; P <.001), female sex (HR, 0.84; 95% CI, 0.81-0.87; P <.001), and high baseline LDL-C levels were significantly associated with longer time to LDL-C control. Factors associated with shorter time to LDL-C control included high Charlson comorbidity index scores and a history of diabetes or stroke.
A multivariable analysis also showed that women were less likely to initiate clinician-recommended statin therapy (odds ratio, 0.82; 95% CI, 0.78-0.88; P <.001).
Study limitations include the observational and single-center design, potentially undocumented instances of nonacceptance, and the lack of data on specific reasons for statin nonacceptance.
“Further research is needed to identify the reasons why patients do not accept statin therapy recommendations and the reasons for higher rates of this important clinical phenomenon among women,” the researchers concluded.
Brown CJ, Chang L-S, Hosomura N, et al. Assessment of sex disparities in nonacceptance of statin therapy and low-density lipoprotein cholesterol levels among patients at high cardiovascular risk. JAMA Netw Open. 2023;6(2):e231047. doi:10.1001/jamanetworkopen.2023.1047