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

Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.