Elsevier

American Heart Journal

Volume 165, Issue 5, May 2013, Pages 665-678.e1
American Heart Journal

Curriculum in Cardiology
Gender and racial disparities in adherence to statin therapy: A meta-analysis

https://doi.org/10.1016/j.ahj.2013.02.011Get rights and content

Background

Significant disparities exist in cardiovascular outcomes based on race/ethnicity and gender. Rates of evidence-based medication use and long-term medication adherence also appear to be lower in racial subgroups and women but have been subject to little attention. Our objective was to evaluate the effect of race/ethnicity and gender on adherence to statin therapy for primary or secondary prevention.

Methods and results

Studies were identified through a systematic search of MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Database of Systematic Reviews (through April 1, 2010) and manual examination of references in selected articles. Studies reporting on adherence to statins by men and women or patients of white and nonwhite race were included. Information on study design, adherence measurement, duration, geographic location, sample size, and patient demographics was extracted using a standardized protocol. From 3,022 potentially relevant publications, 53 studies were included. Compared with men, women had a 10% greater odds of nonadherence (odds ratio 1.10, 95% confidence interval [CI], 1.07-1.13). Nonwhite race patients had a 53% greater odds of nonadherence than white race patients (odds ratio 1.53, 95% CI 1.25-1.87). There was significant heterogeneity in the pooled estimate for gender (I2 0.95, P value for heterogeneity <.001) and race (I2 0.98, P value for heterogeneity <.001). The overall results remained unchanged in those subgroups that had significantly less heterogeneity.

Conclusions

Among patients prescribed statins, women and nonwhite patients are at increased risk for nonadherence. Further research is needed to identify interventions best suited to improve adherence in these populations.

Section snippets

Methods

We performed an electronic search of Medline, EMBASE, ClinicalTrials.gov, and the Cochrane Database of Systematic Reviews through April 1, 2010, for studies that reported adherence to statins.

Results

Our search identified 3,022 unique abstracts, of which 53 studies met our inclusion criteria (Figure 1). These studies included a total of 2,663,638 patients (sample size range 83-962,877), and average adherence in all studies was 48%. Among the 53 included studies, 51 evaluated adherence based on gender8, 9, 17, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64,

Discussion

Racial and gender-based disparities in cardiovascular outcomes have been well described. The reasons for these differences in care are complex, but differences have been documented in the use of invasive cardiovascular procedures as a result of patient preference, greater diagnostic and therapeutic uncertainty, stereotyping, and bias.69 Evidence-based medications, including statins, are a cornerstone of cardiovascular risk reduction, and therefore, disparities in their use may also be

Disclosures

Dr Choudhry is a consultant to Mercer Health and Benefits, Inc. Dr Shrank is a consultant on research methodology to United Healthcare. Dr Brennan is an employee of CVS Caremark.

Acknowledgements

The authors thank Jessica Myers, PhD, for statistical expertise.

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