Women are undertreated for heart disease compared to men

Women are less likely than men to take cholesterol-lowering drugs that could protect their health, according to a new study.

Specifically, compared with older men, Heart disease Not much treated Statins or other cholesterol-lowering drugs are not being used, even though treatment is recommended for both men and women.

The new study also found that women were less likely to be prescribed both a statin and another cholesterol-lowering drug, ezetimibe, if statins alone were not effective.

The findings were presented at the European Society of Cardiology (ESC) meeting in April but have not yet been published in a peer-reviewed journal.

“This is not the first study to show a sex difference in statin therapy, but the first important thing to note is that studies have shown this time and time again, yet the problem is not getting better,” he said. Alexander Turchin, MDAssociate Professor of Diabetes, Endocrinology and Hypertension at Brigham and Women's Hospital.

“There is an urgent need to understand why this is happening and how we can better serve female patients,” he said. health.

Hear what experts say about new research, why gender disparities in heart care persist, and how you can best protect your health.

People with certain types of heart disease Coronary artery disease Often increases LDL cholesterol levelYour risk of heart attack increases. For this reason, these patients can usually benefit from taking some type of cholesterol-lowering medication.

Statins are usually the go-to treatment for people who can tolerate them, and they work by reducing the amount of LDL cholesterol in the blood. If optimal levels cannot be reached with statins alone, patients are usually recommended to add another cholesterol-lowering drug called ezetimibe to their treatment plan. LDL cholesterol targets are the same for men and women.

While these guidelines are clear, this new study suggests there are gaps in care for women with heart disease.

Swedish researchers studied 1,037 men and 415 women who had been diagnosed with coronary artery disease between 2012 and 2020. The average ages of the male and female participants were 68 and 70 years, respectively. None had experienced a heart attack.

The team followed up with participants three years after diagnosis and found that 54% of women and 74% of men were taking cholesterol-lowering drugs, and only 5% of women were taking a statin in combination with ezetimibe, compared with 8% of men.

Additionally, the study found that “the gender gap widened over time, with more women than men discontinuing statin therapy,” Turchin explained.

Across all age groups, substance use was highest after diagnosis but declined in the following years, with the decline being most pronounced among women.

For example, 65% of women under 60 were taking cholesterol-lowering medication the week after their diagnosis; three years later, only 52% were still taking the medication. For men under 60, medication use was much more stable: 79% were taking the medication immediately after diagnosis, and 78% were still taking it several years later.

Overall, men were more likely to meet their LDL cholesterol goals than women.

“Our findings should serve as a wake-up call for the undertreatment of women with heart disease.” Nina Johnston, MD“The researchers found that the effect of serotonin levels in the blood was similar to that of serotonin levels in the blood,” said study author and researcher at Uppsala University in Sweden. press release“Equitable prescribing practices are needed to ensure women receive all recommended treatments and are protected from adverse outcomes.”

The new study follows a series of studies that have uncovered treatment disparities between men and women with heart disease.

More than 20 years ago, Michael Miller, MDDr. John F. Kennedy, professor of cardiovascular medicine at the University of Pennsylvania and the Medical College of Pennsylvania, similarly found significant delays in heart disease care for women.

“The new study extends these findings by including nonstatin therapies (such as ezetimibe) that were not available at the time our study was conducted,” Miller said. health.

More recently, a 2019 report found that 67% of women take statins, compared to about 78% of men. The same survey also found that about 19% of women said they had never been offered statins before, compared to about 14% of men. Women were also more likely to decline statins and less likely to agree that the drugs are safe and effective.

Additionally, a 2023 study found that among older adults at high cardiovascular risk, women were less likely to start statin therapy. In yet another trial, when researchers compared treatments, they found that fewer women met their LDL cholesterol and blood pressure goals.

Johnston said. health Her team is investigating why these differences exist and said further research is needed.

One possible explanation, Johnston said, is that women may be less likely to undergo revascularization procedures or have stents inserted. These patients are routinely seen by cardiologists and tend to have higher rates of cholesterol-lowering medication use, especially compared to patients who are only treated by their primary care physician, she explained.

Experts agree that concern about side effects may be another reason for the disparity. For one, Dr. Johnston said, “more women than men report side effects from statins.”

When I hear about these side effects, muscle painSome women may be afraid to try the drug because of side effects such as nausea, fatigue and headaches, Turchin explained.

Some women may believe that supplements work better or that statins have terrible side effects, “but neither of those are true except in very rare circumstances,” Miller added.

Another reason women may be hesitant is that they generally develop heart disease at an older age than men, which could make them reluctant to add a new drug to their routine, Turchin said.

“Older people are generally the most likely to have heart attacks and strokes,” he added. “They need to have stronger, not weaker, defenses against those.”

The decision as to whether a statin or other cholesterol-lowering drug is needed varies from person to person.

US guidelines state that people at high risk for cardiovascular disease are those with at least one risk factor for heart disease (e.g., Diabetes or High blood pressure.

“Statins should be started as soon as coronary artery disease is diagnosed, or earlier in patients at high risk for cardiovascular disease,” Johnston said.

If you're concerned about how your gender might affect your treatment, Miller suggests asking your health care provider whether women should receive the same heart care treatments as men. If your provider isn't sure, Miller says to find a different doctor.

It's also important that doctors take concerns about statin side effects seriously: If more women are going to take the drugs, it may be beneficial for doctors to gradually increase their patients' dosages, Johnston explained.

“The importance of statin therapy in coronary artery disease needs to be explained to all patients, but especially to women who may be skeptical about its effectiveness,” she said.