Abstract Background Cardiovascular diseases (CVD), for which high cholesterol is a major risk factor, are the leading cause of death worldwide. Management of high cholesterol includes lifestyle modification and the use of lipid-lowering therapy (LLT) medications. However, there are inequalities reported between the CVD related care received by males and females in diagnosis, management, and prevention, though these inequalities and how they interact are poorly understood. Purpose This study aimed to investigate inequalities in cholesterol management, and their relationship with other sociodemographic factors including sex, ethnicity and socio-economic deprivation. Methods The National Audit of Cardiovascular Disease Prevention in Primary Care (CVDPREVENT) in England monitors LLT prescription, as well as low- and non-high-density lipoprotein-cholesterol (LDL-C and non-HDL-C, respectively) levels, among those with or at risk for CVD. This study used the December 2023 extract of the CVDPREVENT dataset and small area deprivation estimates from the English Indices of Deprivation (IoD) 2019 to assess differences in LLT prescription rates and lipid target achievement between men and women with CVD, including by ethnicity and area deprivation quintile, using descriptive statistics and Odds Ratios (OR). Results Data was extracted for 2,627,240 individuals with CVD (61.6% male, 79.7% White). Females were significantly less likely than males to receive a recent (within last 6 months) LLT prescription or achieve threshold cholesterol levels (measured via LDL-C and non-HDL-C) across all deprivation quintiles and ethnic groups. These differences were most pronounced in the least deprived quintile (76.1 vs 86.3%, OR 0.50 95% CI 0.50 to 0.51, p0.001 for LLT prescription; 28.5 vs 38.6%, OR 0.63 95% CI 0.63 to 0.64, p0.001 for threshold achievement). Females in the least deprived quintile were also less likely to receive LLT prescriptions than the most deprived (76.1 vs 81.8%, OR 0.71 95% CI 0.70 to 0.72, p0.001). Where ethnicity was stated, these sex-specific differences were most pronounced in the White group (78.4 vs 86.5%, OR 0.57 95% CI 0.56 to 0.57, p0.001 for LLT prescription; 27.9 vs 37.0%, OR 0.66 95% CI 0.66 to 0.66, p0.001 for threshold achievement). Males and females overall showed similar distribution of recent (within last 12 months) LDL-C and non-HDL-C results, though females generally skewed towards higher results and had a higher proportion of patients above threshold values (LDL-C of 1.8mmol/L) (Figure 1). Conclusions Sex-specific inequalities around cholesterol management persist across all ethnicities and deprivation quintiles. Further work is needed to investigate the reasons behind these inequalities and to provide more robust model-based adjusted estimates. Endeavours should be made to reduce under-prescription of LLTs to females with CVD in order to improve target achievement.Figure 1
Mehta et al. (Sat,) studied this question.