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WOMEN ARE LESS LIKELY TO RECEIVE EVIDENCE-BASED LIPID LOWERING THERAPY: INSIGHTS FROM A MANAGED CARE POPULATION
A1413 JACC April 1, 2014 Volume 63, Issue 12
Prevention Women are Less Likely to Receive Evidence-Based Lipid Lowering Therapy: Insights from a Managed Care Population Poster Contributions Hall C Sunday, March 30, 2014, 3:45 p.m.-4:30 p.m.
Session Title: Prevention: Gender, Race/Ethnicity, and Preventive Interventions Abstract Category: 20. Prevention: Clinical Presentation Number: 1219-135 Authors: JoAnne Foody, Temitope O. Olufade, Dena Ramey, Howard Friedman, Prakash Navaratnam, Kim Heithoff, Brigham and Women’s Hospital, Boston, MA, USA, Merck & Co. Inc, Whitehouse Station, NJ, USA Background: High risk Coronary Heart Disease (CHD) and Atherosclerotic Vascular Disease (AVD) patients are at an increased risk for future CHD or cardiovascular (CV)-related events. This study explored if gender impacts patterns of care in high risk patients stratified by baseline LDL-C levels. Methods: This retrospective study evaluated patients enrolled in a managed care database (Optum Insight®) from 2008 to 2012. The first date of an LDL-C measure was defined as the index date. High risk CHD/AVD males and females ≥18 years old were stratified according to pre-index LDL-C levels (≤70, 71-99, 100-129, 130-159 and ≥160 mg/dL) and examined for12 months from the index date. Male/female patients were 1:1 propensity score matched and categorized as initially treated (IT) or initially untreated (IU) based on a prescription record of a statin or a statin/ ezetimibe combination in the 90 days prior to the index date. Initial medications were assigned a potency based on validated potency tables. Up or down titration and discontinuation for IT patients and treatment initiation for IU were compared by gender in the post-index period. Logistic regression models evaluated if gender was predictive of treatment initiation in IU patients and treatment change in IT patients Results: Unmatched patients numbered 80,082 patients (46,536 males, 33,546 females) and there were 54,506 (27,253 males, 27,253 females) propensity-score matched patients. 20,712 (38%) (34.8% women; 41.2% men; p <0.05) of the patients were treated in the 90 days prior to the index LDL-C measure. Across all LDL-C strata, women were less likely to be initially treated compared to men. Among initially untreated patients, women had a lower odds of post-index treatment initiation (p <0.0001). Among initially treated patients, female patients were more likely to be treated with lower pre-index LLT potency and in the logistic regression models females had consistently higher odds of treatment discontinuation. Conclusions: Across all LDL-C strata, high risk female patients are not as aggressively treated as their male counterparts with females less likely to be treated with high potency LLT, and if initially untreated, less likely to initiate treatment.
Prevention Women are Less Likely to Receive Evidence-Based Lipid Lowering Therapy: Insights from a Managed Care Population Poster Contributions Hall C Sunday, March 30, 2014, 3:45 p.m.-4:30 p.m.
Session Title: Prevention: Gender, Race/Ethnicity, and Preventive Interventions Abstract Category: 20. Prevention: Clinical Presentation Number: 1219-135 Authors: JoAnne Foody, Temitope O. Olufade, Dena Ramey, Howard Friedman, Prakash Navaratnam, Kim Heithoff, Brigham and Women’s Hospital, Boston, MA, USA, Merck & Co. Inc, Whitehouse Station, NJ, USA Background: High risk Coronary Heart Disease (CHD) and Atherosclerotic Vascular Disease (AVD) patients are at an increased risk for future CHD or cardiovascular (CV)-related events. This study explored if gender impacts patterns of care in high risk patients stratified by baseline LDL-C levels. Methods: This retrospective study evaluated patients enrolled in a managed care database (Optum Insight®) from 2008 to 2012. The first date of an LDL-C measure was defined as the index date. High risk CHD/AVD males and females ≥18 years old were stratified according to pre-index LDL-C levels (≤70, 71-99, 100-129, 130-159 and ≥160 mg/dL) and examined for12 months from the index date. Male/female patients were 1:1 propensity score matched and categorized as initially treated (IT) or initially untreated (IU) based on a prescription record of a statin or a statin/ ezetimibe combination in the 90 days prior to the index date. Initial medications were assigned a potency based on validated potency tables. Up or down titration and discontinuation for IT patients and treatment initiation for IU were compared by gender in the post-index period. Logistic regression models evaluated if gender was predictive of treatment initiation in IU patients and treatment change in IT patients Results: Unmatched patients numbered 80,082 patients (46,536 males, 33,546 females) and there were 54,506 (27,253 males, 27,253 females) propensity-score matched patients. 20,712 (38%) (34.8% women; 41.2% men; p <0.05) of the patients were treated in the 90 days prior to the index LDL-C measure. Across all LDL-C strata, women were less likely to be initially treated compared to men. Among initially untreated patients, women had a lower odds of post-index treatment initiation (p <0.0001). Among initially treated patients, female patients were more likely to be treated with lower pre-index LLT potency and in the logistic regression models females had consistently higher odds of treatment discontinuation. Conclusions: Across all LDL-C strata, high risk female patients are not as aggressively treated as their male counterparts with females less likely to be treated with high potency LLT, and if initially untreated, less likely to initiate treatment.