Abstract 4147663: Higher LDL Across Lifespan Among Women: A Real-World Analysis

Introduction: Lower low-density lipoprotein (LDL) leads to greater cardiovascular disease risk reduction over the lifespan. Despite this, women are less likely to reach guideline-recommended LDL goals, perhaps due to bias in statin prescription or statin intensity. and disparities in adherence. There are known sex differences in cardiovascular disease and statin response, but little is known about how these differences manifest under real-world conditions. Aim: We aim to characterize long-term LDL between men and women who have been prescribed statin therapy as a function of age at initial statin therapy. Methods: We retrospectively identified patients within the UCHealth electronic health record among adults from 2012 to 2023 prescribed a statin with at least 3 LDL levels. Patients prescribed concomitant lipid-lowering agents were excluded. We performed a multivariate linear regression model to predict long-term average LDL between genders, adjusting for age at the time of statin prescription, race, ethnicity, BMI, interval from statin prescription, creatinine, and the following diagnoses: diabetes mellitus, ischemic heart disease, ischemic stroke, and smoking history. Results: Among 75,276 encounters, 14,902 patients had at least 3 LDL-C measurements and an interval statin initiation. Post-treatment LDL was obtained 212 (± 177) days after statin initiation. The cohort was 49% (7,303 patients) female, with 86% (12,819) white, 4% (648) African American, and 8% (1,249) Hispanic patients. At age 30, men started on statin therapy had a predicted LDL of 117 (95% CI: 114-121 mg/dL), whereas women began with a predicted LDL of 115 (95% CI: 112-119 mg/dL). At age 70, that value was 94.1 (95% CI: 93.4-94.8 mg/dL) among men vs 105.6 (95% CI: 104.9-106.3 mg/dL) in women (Figure). Discussion: In this single-center, retrospective observational study, we found that women had a higher predicted LDL compared to men across the lifespan, with a greater difference in those whose first prescription was at an older age. More work is needed to determine if this reflects less aggressive treatment of women than men. Further research needs to be done to bridge this gap in therapy.