Statins for secondary prevention in women with atherosclerotic vascular disease: A nation-wide analysis of 24,665 women hospitalized for coronary, cerebrovascular or peripheral artery disease.

Background: Statin therapy is recommended for secondary prevention of atherosclerotic vascular disease (ASCVD) based on randomized trials, which enrolled mostly men with coronary artery disease (CAD), whereas women and patients with cerebrovascular (CVD) and peripheral artery disease (PAD) were under-represented. We analyzed the effectiveness of statin therapy uptake in a nation-wide cohort of women hospitalized for ASCVD. Methods: Women hospitalized for CAD, CVD, or PAD, including aortic disease, between 2015 and 2021 were retrospectively identified by linking the national hospital database, medicines reimbursement claims, and national mortality registry. The association of statin uptake within 30 days post-discharge with clinical outcomes (all-cause mortality and cardiovascular hospitalizations) was assessed by Kaplan-Meier curves and Cox proportional hazards regression model with propensity score-derived inverse probability of treatment weights and a 30-day landmark period. Results: We included 24,665 women with ASCVD - 14,419 with CAD, 5,427 with CVD, and 4,819 with PAD. Overall, the median age was 73 (64-81) years. The rates of statin uptake were 50 % for women with CAD, 60 % for CVD and 28 % for PAD. Statin therapy uptake was associated with a reduction in all-cause mortality and cardiovascular hospitalizations across all three major types of ASCVD: hazard ratio (HR) 0.88, 95 % confidence interval (CI) 0.83-0.93, p = 0.001 for CAD, HR 0.87, 95 % CI 0.80-0.94, p = 0.006 for PAD, and HR 0.72, 95 % CI 0.66-0.78, p < 0.001 for CVD. Conclusion: Statin therapy is associated with reduced all-cause mortality and cardiovascular hospital readmissions in women with all major types of ASCVD.