Despite Risks, Female Veterans with Heart Disease Less Likely to Receive Statins

By Annette M. Boyle
HOUSTON — Heart disease is the No. 1 killer of women veterans, yet they remain undertreated for high cholesterol, one of the main risk factors for cardiovascular disease.

Salim Virani, MD, PhD

Salim Virani, MD, PhD

“This may represent a gap in providers’ understanding of the benefits of statins for women, particularly for those with cardiovascular disease,” said Salim Virani, MD, PhD, cardiologist at the Michael E. DeBakey VA Medical Center, an investigator at the Center for Innovations in Quality, Effectiveness and Safety and an assistant professor at the Baylor College of Medicine in Houston.
Previous studies have found that female patients with cardiovascular disease (CVD) are less likely to have low density lipids (LDL-C) of less than 100 mg/dL. That target was, until late 2013, the level of LDL the American College of Cardiology and the American Heart Association recommended physicians try to achieve in patients with cardiovascular disease.
The current guidelines eschew a specific target, instead recommending that all patients with CVD receive a high-intensity statin therapy.

But Virani and his colleagues found in a study published in the American Journal of Cardiology that women veterans with cardiovascular disease are undertreated by this measure as well.1
“Female veterans with diagnosed heart disease or a history of stroke are 32% less likely to receive statins and less likely to receive high-intensity statins than male veterans,” he told U.S. Medicine.
The researchers analyzed data from 972,532 patients receiving care in 130 VHA facilities from Oct. 1, 2010, to Sept. 30, 2011. All the patients had diagnoses of coronary heart disease, peripheral artery disease or ischemic stroke. Of the patients, 13,371 were female and 959,161 were male.

They found that 57.6% of women received any statin therapy and 21.1% received a high-intensity therapy, compared with 64.8% of men on any statin therapy and 23.6% of men taking high-intensity statins.

Click image to view a full size graphic

Click image to view a full size graphic

All of the cholesterol measures were higher for women with CVD than for men. Mean LDL levels for women were 99 mg/dL compared with a mean for men of 85 mg/dL. Other measures also were higher by 25 mg/dL for total cholesterol, 6 mg/dL for triglycerides, 9 mg/dL for HDL-C and 15 mg/dL for non-HDL-C in female patients than in male patients.
The proportion of women veterans receiving statins also varied significantly by facility, from a high of about 71% to a low approaching 35%. For high-intensity statins, the range was greater, with a high of nearly 40% and a low of about 7%.

The lower rates of women veterans on statins may be due to some confusion about the effectiveness of the therapy in this population.

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