Uptitration of statin therapy in women and men: a population-based cohort study

Aims Statins are widely used for the prevention and management of cardiovascular disease (CVD). Women have been shown to be less likely to receive guideline-recommended dose of statins and reach target lipid levels. This study aims to examine sex differences in titration patterns of statin therapy and in the attainment of cholesterol targets in a Dutch healthcare setting. Methods and results Data on statin dispensing was extracted from the PHARMO Data Network between 2011 and 2020. New-statin users with at least two recorded statin dispenses were included. Cox proportional hazards models were used to study the association between sex and time to first uptitration of intensity and Poisson regressions were used to estimate sex differences in the attainment of cholesterol targets within 6 and 18 months after statin initiation. We identified 68 150 new users of statin therapy (46% women) with a median age of 65 years [Q1–Q3: 57–72]. The cumulative incidence of uptitration after 3 years of follow-up was 10% in women and 12% in men. After adjustment for age, CVD and other individual characteristics, women were 28% less likely to be uptitrated compared to men (adjusted hazard ratio for women vs. men 0.72 [95% confidence interval (CI) 0.69–0.75]). The adjusted risk ratio of achieving cholesterol target levels within 6 and 18 months after statin initiation in women vs. men were 0.95 (95% CI 0.93–0.97) and 0.98 (95% CI 0.97–0.99). Conclusion Among new statin users, women are less likely to be uptitrated compared to men and to achieve cholesterol target levels.