Drivers of the Sex Disparity in Statin Therapy in Patients with Coronary Artery Disease: A Cohort Study.
Drivers of the Sex Disparity in Statin Therapy in Patients with Coronary Artery Disease: A Cohort Study.
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冠状动脉疾病患者他汀类药物治疗中性别差异的驱动因素：一项队列研究
DOI：
10.1371/journal.pone.0155228
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Turchin A
中科院分区：
文献类型：
--
作者：
Zhang H;Plutzky J;Shubina M;Turchin A
背景：女性比男性更不可能被处方他汀类药物。现有的报告只解释了这种差异的一小部分。我们进行了一项研究，以确定在冠心病（CAD）患者中他汀类药物治疗的性别差异的因素。方法和结果我们回顾性研究了2000年至2011年期间在两个学术医学中心随访至少一年的24，338例CAD患者。女性（9，006/ 37%的研究患者）在随访结束时开始他汀类药物治疗（81.9%女性vs. 87.7%男性）或持续接受他汀类药物治疗（67.0%女性vs. 71.4%男性）的可能性较小。女性年龄更大（72.9 vs. 68.4岁），不太可能吸烟（49.8% vs. 65.6%），不太可能接受心脏病专家的评估（57.5% vs. 64.5%），更可能报告他汀类药物的不良反应（27.1% vs. 21.7%）（所有p < 0.0001）。在多变量分析中，有吸烟史（OR 1.094; p 0.017）、年龄较小（OR 1.013 /年）、心脏病专家评估（OR 1.337）和未报告他汀类药物不良反应（OR 1.410）的患者更有可能（所有患者p < 0.0001）持续接受他汀类药物治疗。这四个因素加在一起造成了持续他汀类药物治疗中性别差异的90.4%。结论：一些特定因素似乎是女性与男性不同他汀类药物治疗的基础。确定这些驱动因素可能会促进方案干预措施，并刺激进一步研究，以克服性别差异，应用行之有效的干预措施，降低心血管风险。
Background Women are less likely to be prescribed statins than men. Existing reports explain only a fraction of this difference. We conducted a study to identify factors that account for sex differences in statin therapy among patients with coronary artery disease (CAD). Methods and Results We retrospectively studied 24,338 patients with CAD who were followed for at least a year between 2000 and 2011 at two academic medical centers. Women (9,006 / 37% of study patients) were less likely to either have initiated statin therapy (81.9% women vs. 87.7% men) or to have persistent statin therapy at the end of follow-up (67.0% women vs. 71.4% men). Women were older (72.9 vs. 68.4 years), less likely to have ever smoked (49.8% vs. 65.6%), less likely to have been evaluated by a cardiologist (57.5% vs. 64.5%) and more likely to have reported an adverse reaction to a statin (27.1% vs. 21.7%) (p < 0.0001 for all). In multivariable analysis, patients with history of smoking (OR 1.094; p 0.017), younger age (OR 1.013 / year), cardiologist evaluation (OR 1.337) and no reported adverse reactions to statins (OR 1.410) were more likely (p < 0.0001 for all) to have persistent statin therapy. Together, these four factors accounted for 90.4% of the sex disparity in persistent statin therapy. Conclusions Several specific factors appear to underlie divergent statin therapy in women vs. men. Identifying such drivers may facilitate programmatic interventions and stimulate further research to overcome sex differences in applying proven interventions for cardiovascular risk reduction.