Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery disease

Current guidelines recommend using high-intensity statins in patients with atherosclerotic cardiovascular disease (ASCVD). Guideline directed statin intensity (GDSI) implementation and ASCVD outcomes may differ by sex. We evaluated sex-based differences in GDSI use and recurrent ASCVD outcomes in a large healthcare network. Using electronic medical records, we assessed statin use and intensity in a cohort of patients with established coronary artery disease (coronary artery bypass grafting or percutaneous coronary intervention) between 2010-2022. Statins were categorized into GDSI (high intensity), <GDSI (moderate or low intensity) or no statin use. Outcomes of interest included recurrent myocardial infarction (MI), stroke/TIA and all-cause mortality. Incident rates (IR) and Cox regression hazard ratios (HR) of ASCVD outcomes were calculated across statin categories, stratified by sex. We amassed data from 45,949 patients, of which 31 % were women. Women had more diabetes (29 % vs 24 %) and higher low density lipoprotein cholesterol [LDL-C] (94.9 ± 40.8 vs 87.6 ± 37.1 mg/dL) than men. During a follow-up period of ∼5 years, women were less likely to be started on GDSI (61.6 % vs 65.8 %, p<0.01) and achieve LDL-C<70mg/dL (41 % vs and 49 %, p<0.01) as compared to men. GDSI use lowered IRs for all outcomes in both sexes . As compared to men, women on GDSI had higher risk of MI (HR 1.21 [1.12-1.31)], stroke (1.21 [1.08-1.34] and mortality (1.12 [1.05-1.20]), all p<0.01). In a contemporary cohort of patients with coronary artery disease, women were less likely to be prescribed GDSI than men and less likely to achieve guideline concordant LDL-C<70mg/dL. This was associated with a higher risk of recurrent ASCVD events in women as compared to men. More sex specific interventions are needed to ensure adequate preventive treatment for both sexes.