Evidence map›Statins × costs & health-care use›PMID 31416347›Full record

Observational studyCirculation. Cardiovascular quality and outcomes2019

Sex Differences in the Use of Statins in Community Practice.

Michael G Nanna, Tracy Y Wang, Qun Xiang, Anne C Goldberg, Jennifer G Robinson, Veronique L Roger, Salim S Virani, Peter W F Wilson, Michael J Louie, Andrew Koren and 3 more

Abstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Circulation. Cardiovascular quality and outcomes, 2019. The graph read 2 numbers from its abstract, feeding 1 cell of the map, but none could be read as for or against, so it casts no vote. It also reports 2 associations that do not count as treatment evidence, such as OR 0.82 (0.73 to 0.92) for costs & health-care use. Cited by 180 papers, 6 of them syntheses that pooled it.

2numbers the graph read from it
0cells of the map it votes in
180citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

Read, but not usablea number the graph found but could not read as for or against

Costs & health-care usean association or prognostic statement, not a treatment comparison · ascvd, dyslipidemiafeeds one cell of the map
OR 0.820.73 to 0.92P<0.01
Sex differences in both overall and guideline-recommended intensity statin use persisted after adjustment for demographics, socioeconomic factors, clinical characteristics, patient beliefs, and provider characteristics (adjusted odds ratio, 0.70; 95% CI, 0.61-0.81; P<0.001; and odds ratio, 0.82; 95% CI, 0.73-0.92; P<0.01, respectively).
FeedsStatins×costs & health-care use
Costs & health-care usean association or prognostic statement, not a treatment comparison · ascvd, dyslipidemiafeeds one cell of the map
OR 0.700.61 to 0.81P<0.001
Sex differences in both overall and guideline-recommended intensity statin use persisted after adjustment for demographics, socioeconomic factors, clinical characteristics, patient beliefs, and provider characteristics (adjusted odds ratio, 0.70; 95% CI, 0.61-0.81; P<0.001; and odds ratio, 0.82; 95% CI, 0.73-0.92; P<0.01, respectively).
FeedsStatins×costs & health-care use

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×costs & health-care use

No readable resultOpen on the map →What to test next →

1 readable study in this cell: 0 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.25no deciding trial · 0 families support, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
Quality Improvement and Personalization for Statins: the QUIPS Quality…PMID 30284172 · 43 enrolled · 2016
OR 1.700.99 to 2.77

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

180 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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  12. Preventive Cardiovascular Medication Prescribing Patterns in Menopausal Women.Mayo Clinic proceedings. Innovations, quality & outcomes · 2026
    Article
  13. Review
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120 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

13 authors.

Michael G NannaDepartment of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., T.Y.W., Q.X., Z.L., E.D.P., A.M.N.).
Tracy Y WangDepartment of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., T.Y.W., Q.X., Z.L., E.D.P., A.M.N.).
Qun XiangDepartment of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., T.Y.W., Q.X., Z.L., E.D.P., A.M.N.).
Anne C GoldbergDepartment of Medicine, Washington University, St. Louis, MO (A.C.G.).
Jennifer G RobinsonDepartment of Epidemiology, University of Iowa College of Public Health (J.G.R.).
Veronique L RogerDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.).
Salim S ViraniDepartment of Medicine-Cardiology, Baylor College of Medicine, Houston, TX (S.S.V.).
Peter W F WilsonDepartment of Medicine, Atlanta Veterans Affairs Medical Center and Emory Clinical Cardiovascular Research Institute, GA (P.W.F.W.).
Michael J LouieRegeneron Pharmaceuticals, Inc, Tarrytown, NY (M.J.L.).
Andrew KorenSanofi, Bridgewater, NJ (A.K.).
Zhuokai LiDepartment of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., T.Y.W., Q.X., Z.L., E.D.P., A.M.N.).
Eric D PetersonDepartment of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., T.Y.W., Q.X., Z.L., E.D.P., A.M.N.).
Ann Marie NavarDepartment of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., T.Y.W., Q.X., Z.L., E.D.P., A.M.N.).

Funding

Postdoctoral Training in Cardiovascular Clinical ResearchT32HL069749 · NHLBI · DUKE UNIVERSITY · PI MARK, DANIEL B · 2003 to 2023
$6.7M
Preventing Cardiovascular Disease through Improved Risk Prediction and CommunicationK01HL133416 · NHLBI · DUKE UNIVERSITY · PI NAVAR, ANN MARIE · 2016 to 2020
$707k
NHLBI NIH HHS K01 HL133416NHLBI NIH HHS T32 HL069749
8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundFemale patients have historically received less aggressive lipid management than male patients. Contemporary care patterns and the potential causes for these differences are unknown. METHODS AND

resultsExamining the Patient and Provider Assessment of Lipid Management Registry-a nationwide registry of outpatients with or at risk for atherosclerotic cardiovascular disease-we compared the use of statin therapy, guideline-recommended statin dosing, and reasons for undertreatment. We specifically analyzed sex differences in statin treatment and guideline-recommended statin dosing using multivariable logistic regression. Among 5693 participants (43% women) eligible for 2013 American College of Cardiology/American Heart Association Cholesterol Guideline-recommended statin treatment, women were less likely than men to be prescribed any statin therapy (67.0% versus 78.4%; P<0.001) or to receive a statin at the guideline-recommended intensity (36.7% versus 45.2%; P<0.001). Women were more likely to report having previously never been offered statin therapy (18.6% versus 13.5%; P<0.001), declined statin therapy (3.6% versus 2.0%; P<0.001), or discontinued their statin (10.9% versus 6.1%; P<0.001). Women were also less likely than men to believe statins were safe (47.9% versus 55.2%; P<0.001) or effective (68.0% versus 73.2%; P<0.001) and more likely to report discontinuing their statin because of a side effect (7.9% versus 3.6%; P<0.001). Sex differences in both overall and guideline-recommended intensity statin use persisted after adjustment for demographics, socioeconomic factors, clinical characteristics, patient beliefs, and provider characteristics (adjusted odds ratio, 0.70; 95% CI, 0.61-0.81; P<0.001; and odds ratio, 0.82; 95% CI, 0.73-0.92; P<0.01, respectively). Sex differences were consistent across primary and secondary prevention indications for statin treatment.

conclusionsWomen eligible for statin therapy were less likely than men to be treated with any statin or guideline-recommended statin intensity. A combination of women being offered statin therapy less frequently, while declining and discontinuing treatment more frequently, accounted for these sex differences in statin use.

Indexed as

Medication AdherenceAgedCardiovascular DiseasesCommunity Health ServicesDyslipidemiasFemaleGuideline AdherenceHealthcare DisparitiesHealth Knowledge, Attitudes, PracticeHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPractice Guidelines as TopicPractice Patterns, Physicians'Primary PreventionHydroxymethylglutaryl-CoA Reductase Inhibitorsprimary preventionsecondary preventionsexsex characteristicswomen

Identifiers

PMID31416347
PMCPMC6903404

What OpenQuestion holds

Texttitle and abstract
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.