The strongest predictor of not meeting cholesterol goals? Being a woman
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Key takeaways:
- Eleven percent of patients in Italy achieved guideline-recommended targets for LDL (“bad” cholesterol).
- Female sex was an independent predictor of not meeting LDL targets.
Data from a real-world cohort in Italy show female sex is the only independent variable associated with lower probability of achieving LDL target level for every risk category, regardless of whether the patient is prescribed statin therapy.
“Regardless of CV risk category, female gender emerged as strongest independent predictor of failure to achieve LDL targets,” Martina Berteotti, MD, PhD, of the department of experimental and clinical medicine at the University of Florence, Italy, and colleagues wrote in the study background. “This gender disparity has been consistently observed in several previous registries. Importantly, this finding was consistent regardless of background lipid-lowering therapy, indicating a bias in both the inadequate prescription and titration of lipid-lowering therapy in women.”
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Berteotti and colleagues analyzed health administrative and laboratory data from 174,200 adults aged 45 years and older with a history of major adverse cardiac or cerebrovascular events and/or type 2 diabetes (55% men; mean age, 72 years). Researchers assessed the number of patients with optimal levels of LDL, defined as less than 55 mg/dL for patients with a history of major adverse cardiac events and less than 70 mg/dL for those with a history of type 2 diabetes.
The findings were published in Nutrition, Metabolism and Cardiovascular Diseases.
Overall, 51.6% of patients did not receive lipid-lowering therapies despite only 22.7% of patients having an LDL at the target level. Among those prescribed lipid-lowering therapies, 43.8% received statin monotherapy; fewer than 4% of patients were prescribed ezetimibe or combination therapy.
The recommended LDL goals outlined in the 2019 European Society of Cardiology guidelines were achieved by 11.6% of patients, with the lowest rate of goal attainment seen among patients with a history of major adverse cardiac and cerebrovascular events without type 2 diabetes. Treated patients were more likely to achieve LDL targets vs. untreated patients (18.6% vs. 5.1%; P < .001). Women were less likely than men to be prescribed any lipid-lowering therapy and had less attainment of LDL targets than men (8.8% vs. 14%; P < .001).
Female sex was the only independent predictor of not achieving LDL targets in every risk category, regardless of the use of lipid-lowering therapy, with an overall adjusted incidence rate ratio of 0.58 for patients prescribed lipid-lowering therapy (95% CI, 0.55-0.62; P < .001) and an adjusted incidence rate ratio of 0.56 for patients not treated with lipid-lowering therapy (95% CI, 0.54-0.58; P < .001).
Among patients with type 2 diabetes, researchers found that hypertension and chronic kidney disease were independently associated with a higher likelihood of achieving LDL targets.
“In particular, women still have the highest risk of being undertreated according to guidelines recommendations irrespectively from their risk category and background therapy,” the researchers wrote.
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