Women Are Significantly Underdiagnosed and Undertreated for Heart Disease Compared to Men, According to New Study

The probability of women receiving cholesterol-reducing medication is significantly lower than men, as reflected in a recent study.

The finding indicates that older women suffering from heart disease are not often treated with statins or other types of cholesterol-reducing medication compared to older men, even though both groups are recommended the same treatment.

The study also highlighted that women were less frequently prescribed both statins and ezetimibe, an alternative cholesterol-reducing drug, when statins alone fail to work.

This research was presented in a European Society of Cardiology (ESC) conference held in April, however, it has not been published in any peer-reviewed journal yet.

Alexander Turchin, MD, Associate Professor of Diabetes, Endocrinology, and Hypertension at Brigham and Women’s Hospital commented on the study. "Despite several earlier studies indicating gender disparities in statin therapy, the problem still persists to this date." He further stressed the need to comprehend the situation better and work on providing improved care for their female patients.

Several experts shed light on this new research, the persisting gender disparities in heart disease care and how to best protect your health.

People diagnosed with a specific kind of heart disease, namely coronary artery disease have elevated LDL cholesterol levels, making them highly susceptible to heart attacks. Cholesterol-reducing drugs are typically prescribed to these patients.

For those who can tolerate, statins are usually the preferred treatment as these can decrease LDL Cholesterol levels in the blood. If statins alone aren't sufficient, an additional cholesterol-reducing drug, ezetimibe, is recommended. Both men and women are expected to reach the same target levels of LDL cholesterol.

However, this research has shown that women with heart disease are not receiving as much treatment as they should be.

The team of researchers from Sweden explored data of 1,037 men and 415 women diagnosed with coronary artery disease between 2012 and 2020. The male and female group had average ages 68 and 70 respectively, with none of them having experienced heart attack.

A follow up was conducted with participants three years after their diagnosis revealing that a lesser percentage of women (54%) were using cholesterol lowering drugs compared to men (74%). Only 5% of the women were taking both a statin and ezetimibe as compared to 8% of the men.

The research discovered that the gap between men and women increased with time. More women discontinued statin therapy over time compared to men. At all ages, medication usage was seen highest when people were first diagnosed and gradually decreased with time, notably more in women.

For women under 60, 65% of them were on cholesterol lowering drugs immediately after their diagnosis. After three years, only 52% were still on medication. In case of men under 60, the consistency was noticeable, with almost 79% on medication immediately after diagnosis and 78% still on it after years.

In general, men were seen to achieve their LDL cholesterol objectives more than women.

“This should serve as a wake-up call about the neglect of women with heart disease”, said study author and Uppsala University researcher Nina Johnston, MD, PhD. She emphasized the necessity of equal prescribing practices to ensure women are not denied the recommended therapies and protection from adverse consequences.

This research builds on a long history of studies discovering disparities in treatment of heart disease among men and women.

Michael Miller, MD, Professor of Cardiovascular Medicine at the University of Pennsylvania and Penn Medicine, disclosed a similar disparity in women's treatment for heart disease over 20 years ago.

Miller further added, "This recent study not only adds to those findings, but includes non-statin therapies like ezetimibe, which were not available during our study."

A study in 2019 reported that only 67% of women as compared to 78% of men were on a statin. The same study reported that approximately 19% women said they were never offered a statin, as compared to about 14% of men. Women were more likely to decline statin and were less likely to agree that the drugs were safe and effective.

An additional study projected for 2023 revealed that older women at a high risk of cardiovascular diseases were less likely to begin statin therapy compared to men. Yet another trial revealed that a lesser number of women achieved their LDL cholesterol and blood pressure targets compared with men.

Johnston told Health that her team is investigating why these disparities exist, and that further research is needed.

One possible explanation, Johnston said, is that women may be less likely to undergo a revascularization process, or receive a stent. These patients are always evaluated by cardiologists, and tend to have higher usage rates of cholesterol-lowering drugs, especially as compared to patients who are only treated by primary care doctors, she explained.

Concerns about side effects could be another driver of these disparities, experts agreed. For one, Johnston said, “more women than men report side effects of statins.”

Hearing stories about these side effects—which include muscle aches, fatigue, headache, and more—could make some women afraid to try the drugs, Turchin explained.

Some women may believe that supplements can work better, or that statins have devastating side effects, “neither of which are true except in very rare circumstances,” Miller added.

Another reason why women may hesitate: They typically develop heart disease at an older age than men do, and may be reluctant to add another medication to their routine, said Turchin.

“Older people are generally the most likely to get a heart attack or a stroke,” he added. “They need more protection from them, not less.”

Determining whether you need statins or other cholesterol-lowering medications depends on each individual.

U.S. guidelines recommend doctors prescribe statins to anyone ages 40 to 75 who has a higher risk of a cardiovascular disease and at least one risk factor for heart disease, such as diabetes or hypertension.

“Statins should be started once a diagnosis of coronary artery disease is made, or earlier in patients at high cardiovascular risk,” said Johnston.

If you’re concerned about how gender may be impacting your care, Miller suggested asking your healthcare provider to confirm that women should be getting the same treatment for heart disease as men. If the provider is unclear, seek out a different doctor, he said.

It’s also important that physicians take concerns about statin side effects seriously. If it means more women take the drugs, it may be helpful for doctors to slowly increase medication doses in female patients over time, Johnston explained.

“The importance of statin treatment in coronary artery disease needs to be explained to all patients, but especially women who appear to be more skeptical as to the benefits,” she said.