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Publication Briefs

Women Veterans with Premature Cardiovascular Disease Less Likely than Men to Receive Secondary Prevention Therapy

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide. To curb this trend, secondary prevention guidelines recommend initiating antiplatelet and statin therapy after an ASCVD event, defined as ischemic heart disease, ischemic cerebrovascular disease, or peripheral arterial disease. Although men and women derive equal benefit from secondary prevention, cardiovascular care disparities persist between the sexes. This retrospective cohort study sought to evaluate sex-based differences in antiplatelet use, any statin and high-intensity statin (HIS) therapy, and statin adherence among patients with premature and extremely premature ASCVD. Using VA data from FY2015, investigators identified 147,600 Veteran patients with premature ASCVD; more specifically, they identified 10,413 women and 137,187 men with premature (age £55 years) and 1,340 women and 8,145 men with extremely premature (age ≤40 years) ASCVD. In addition, investigators gathered information regarding patient demographics, including body mass index, as well as comorbid hypertension, diabetes, major depressive disorder, and PTSD. They also assessed low-density lipoprotein cholesterol (LDL-C) levels, and statin-associated side effects. Primary outcomes included outpatient antiplatelet use, any statin and HIS therapy, and statin adherence. VA and non-VA prescriptions were included.


  • Women Veterans with premature (age £ 55 years) and extremely premature (age £ 40 years) ASCVD were less likely to receive antiplatelet agents or statins than men. Adjusted analyses showed that premature ASCVD women, compared with men, were significantly less likely to receive antiplatelets (61% vs. 79%), any statin (58% vs. 75%), or HIS therapy (24% vs. 38%).
  • Women with premature ischemic heart disease were comparatively less statin adherent.
  • Relative to women of other races, Black women were less likely to receive some therapies but also more likely to receive others. There was no heterogeneity observed regarding statin adherence.
  • Overall, both sexes received sub-optimal aspirin and statin therapy and had poor statin adherence.


  • A systematic approach towards healthcare delivery improvement and patient education is necessary to narrow this healthcare disparity for women.


  • The observational design of this study and EMR constraints limited assessment of variables such as statin or aspirin contraindications, aspirin allergies and over-the-counter use, outside-VA pharmacy usage, and lifestyle modifications.

This study was funded by HSR&D (IIR 16-072). Drs. Lee, Mahtta, Ramsey, Petersen, and Virani are part of HSR&D’s Center for Innovation in Quality, Effectiveness, and Safety (IQuESt).

Lee M, Mahtta D, Ramsey D, Liu J, Misra A, Nasir K, Samad Z, Itchhaporia D, Khan S, Schofield R, Ballantyne C, Petersen L, and Virani S. Sex-related Disparities in Cardiovascular Healthcare among Patients with Premature Atherosclerotic Cardiovascular Disease. JAMA Cardiology. April 21, 2021; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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