Key result
Women were significantly less likely to reach contemporary LDL-C goals compared to men following lipid-lowering therapy initiation or intensity change (HR 0.78; 95% CI 0.73-0.82).
Why the study?
Cardiovascular diseases show differences between sexes, and more evidence was needed to assess the role of sex in attaining LDL-C goals.
Does female sex reduce the likelihood of achieving LDL-C goals compared to male sex in patients initiating or changing lipid-lowering therapy?
Cohort (n=30,323)
Yes
Does female sex reduce the likelihood of achieving LDL-C goals compared to male sex in patients initiating or changing lipid-lowering therapy?
Effect estimate: HR 0.78 (95% CI 0.73-0.82)
Women are significantly less likely than men to achieve guideline-directed LDL-C goals after adjusting for lipid-lowering therapy intensity, age, and cardiovascular risk, highlighting a sex disparity in lipid management.
May signal need for closer monitoring of women on lipid-lowering therapy; leaves open whether sex-specific strategies improve goal attainment.
BACKGROUND AND AIMS: Cardiovascular (CV) diseases show clear differences in clinical manifestation and treatment outcomes between men and women. To reduce sex disparities in achieving lipid-lowering therapy (LLT) goals, a sex-focused assessment is essential and more studies are needed to bring new evidence to clinicians. This study aims to assess the role of sex in attaining low-density lipoprotein cholesterol (LDL-C) goals, after correction for age, CV risk category, LLT intensity, and presence of mental health disorder and social deprivation. METHODS: A retrospective cohort analysis of patients aged 40-85, followed in 1 hospital and 14 primary care centers in Portugal, using electronic health records from 1/1/2012 to 31/12/2020, was performed. The analysis considered an episode-based design, where exposure consists of any time when LLT was started or intensity changed. The likelihood of reaching the LDL-C goal according to contemporary ESC/EAS guidelines was modeled using multivariate Cox regression. LDL-C goal achievement at 180 days was defined as the outcome. The analysis was repeated at 30-day follow-up intervals up to 360 days, and also stratified by CV risk category. RESULTS: We identified 40,032 exposure episodes (LLT initiation or intensity change) in 30,323 distinct patients. Male sex, older age, lower CV risk and increasing LLT intensity were associated with improved LDL-C control. Women were 22% less likely to reach the LDL-C goal than men (HR = 0.78, 95% CI:0.73, 0.82) independently of covariates. CONCLUSIONS: Women have a lower likelihood of attaining LDL-C goals than men after adjustment for LLT intensity, age, CV risk category, presence of mental health disorder and social deprivation. This finding underscores the need for further investigation and tailoring of LLT management strategies in women.
No takes yet. Share an insight, caveat, or question.
Gavina et al. (2023) conducted a cohort in Patients on lipid-lowering therapy (n=30,323). Female sex vs. Male sex was evaluated on LDL-C goal achievement at 180 days (HR 0.78, 95% CI 0.73-0.82). Women were significantly less likely to reach contemporary LDL-C goals compared to men following lipid-lowering therapy initiation or intensity change (HR 0.78; 95% CI 0.73-0.82).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: