Women Substantially More Likely Than Men to Decline Statin Therapy

Female doctor shows elderly female patient something on paper in doctor's office, diagnosis concept

Numerous studies have established that many individuals at high cardiovascular risk, especially women, are not being treated with statins. One reason may be that patients don’t accept clinicians’ treatment recommendations.

In the first large, population-based cohort study of the issue, researchers at Brigham and Women’s Hospital found 22% of eligible patients declined statin therapy initially and 6% never accepted the recommendation. Results on both measures were significantly higher for women than men. They also found that patients who declined statin therapy were subsequently less likely to achieve control of low-density lipoprotein cholesterol (LDL-C) within one year.

C. Justin Brown, PharmD, of the Division of Endocrinology, Diabetes and Hypertension at the Brigham, Alexander Turchin, MD, MS, director of Quality in Diabetes in the Division, and colleagues report in JAMA Network Open.


The retrospective study included 24,212 patients with elevated LDL-C levels, who were at high cardiovascular risk, and were treated between January 1, 2000, and December 31, 2018. The mean age was 59 and 51% were women.

Natural language processing, a form of artificial intelligence, was used to review 4,575,430 narrative notes in the patients’ electronic health records to identify instances of nonacceptance of statin therapy.

A patient was entered into the study on the first date that statin therapy was recommended by a healthcare professional. Patients exited the study on the first of the following: death, loss to follow-up, or December 31, 2018.

Sex Differences in Statin Acceptance

Women were significantly more likely than men to:

  • Decline the initial statin therapy recommendation (24% vs. 20%; P<0.001)
  • Never initiate a statin during follow-up (7.2% vs. 4.8%; P<0.001)

Findings were similar among patients with known coronary artery disease and all other comorbidity subgroups.

In multivariable analysis, women were 18% less likely than men to agree to take a statin upon first recommendation by a clinician (OR, 0.82; P<0.001).

Time to LDL-C Control

The primary study outcome was time from study entry to the first measurement of an LDL-C level <100 mg/dL. The median interval was 1.5 years for patients who accepted statin therapy and 4.4 years for those who did not (P<0.001).

In multivariate analysis, female sex was an independent risk factor for a longer time to achieve LDL-C control (HR, 0.84; 95% CI, 0.81–0.87; P<0.001).

An Important Clinical Phenomenon

The sex disparity in the nonacceptance of statin therapy increased as time went on. Over the entire course of the study, women were 50% more likely than men to continually decline statins.

The lower rates of statin acceptance for women may contribute to the known sex disparities in LDL-C control. These findings shed light on an important aspect of preventing cardiovascular disease.

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