• Researchers report that men with heart disease are treated with statins more often than women with the same condition.
  • They note that cholesterol-lowering medications are used more frequently immediately after a diagnosis and decline over the next three years, with the decline more pronounced in women.
  • Women develop heart disease less often than men but have a higher rate of death from it.

Men with heart disease are treated for high cholesterol more often than women with heart disease, according to research presented at the ESC Preventive Cardiology 2024, a scientific congress of the European Society of Cardiology.

In their study, which hasn’t been published yet in a peer-reviewed journal, the scientists from Sweden examined electronic health records of 1,452 people (1,037 men and 415 women) with a chronic cardiac syndrome diagnosed between 2012 and 2020.

The subjects had a mean age of 68 for men and 70 for women. None of the participants had previously had a heart attack.

The researchers looked at data on cholesterol levels and dispensed medication from the Swedish National Prescribed Drug Registry.

Participants were followed up for three years following their diagnosis. At the end of the third year, 54% of women had been treated with cholesterol-lowering medications compared with 74% of men. Five percent of women were treated with statins compared to 8% of men.

The researchers also examined cholesterol levels in individuals diagnosed with coronary syndrome and treatments in different age groups:

  • Less than 60
  • 60 to 69
  • 70 to 79
  • 80 and older

The scientists reported that prescriptions of cholesterol-lowering treatment (statins) were highest immediately following diagnosis and declined over the next three years in all age groups.

The decline was more pronounced in women compared to men.

The study authors reported that for people younger than 60, 65% of women and 79% of men received cholesterol-lowering medication after diagnosis. Three years later, 52% of women and 78% of men continued to receive this treatment.

Reaching and maintaining target LDL cholesterol levels was lower in women than in men.

“Data has shown that providers did not offer statins as often as men,” said Dr. Laxmi Mehta, a cardiologist at The Ohio State University Wexner Medical Center who was not involved in the study.

“One barrier has been the complexity of prescribing medications during the childbearing years,” Mehta explained to Healthline. “When recommended statin therapy, women were more likely to decline it and more likely to discontinue it after starting treatment. Women have less belief in the safety and effectiveness of statins in preventing heart disease.”

The disparity isn’t just when treating cholesterol issues.

According to an article in the International Journal for Equity in Health, gender disparity in healthcare is embedded in the health system.

The authors noted that over a 21-year period, women were diagnosed later than men for more than 700 different diseases.

“The study highlights an unfortunate inequity in our health system that has led to the under-treatment of women with heart disease,” said Dr. Sameer Amin, the chief medical officer of the LA Care Health Plan in California who was not involved in the study. “As a medical community, we need to ensure equal access to preventative care and refashion our prescribing practices so they are agnostic to patients’ gender, ethnicity, background, and beliefs.”

“As with most entrenched issues, the disparity is multifactorial,” Amin told Healthline. “Changing course will require a more aligned system of care that addresses these inequities head-on. We need to push toward a more algorithmic approach to cardiac care. Similar to goal directed therapy for treating blood-borne infections, we know the right thing to do and when. We need to ensure that our prescribing practices have automatic triggers and reminders so that patients do not fall through the gaps. More can also be done to strengthen primary care while focusing on culturally sensitive care.”

Experts say there isn’t just one reason for the disparity.

“While I don’t think it is intentional, women get lesser care than men in healthcare settings,” said Dr. Yu-Ming Ni, a cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in California who was not involved in the study. “In the recent past, the American Heart Association has worked to raise awareness of heart disease in women. There is a fallacy that men get heart disease more than women, but that is ignoring the fact that heart disease is the number one killer of men and women.”

“We need to keep pushing awareness and place more emphasis on gender-based care. I think about disparities a lot— not just gender but socioeconomic ones as well,” Ni told Healthline. I hope that the newer generation of doctors is more aware of gender bias.”

Women develop cardiovascular disease less often than men, according to a study published in 2023.

However, they have a higher rate of death from cardiovascular disease. The authors of the study note that cardiovascular disease is under-recognized and often untreated in women.

“Despite statins reducing risks of heart attacks and strokes, historically in the U.S., women have also received less aggressive treatment than men in terms of cholesterol management,” Mehta said.

Cholesterol-lowering medications such as statins are recommended for both men and women with coronary artery disease. They can help reduce symptoms and prevent heart attacks and death. If statins alone do not lower cholesterol levels, the European Society of Cardiologists recommends adding a second medication, such as ezetimibe (Zetia/Vytorin).

“I have noticed that most patients with statin intolerance are women,” Ni said. “This might explain less ongoing treatment with statins, but it wouldn’t explain the disparity in initial prescriptions for them.”

Despite the same recommendations for men and women, women are less likely to reduce their cholesterol and achieve the target level.

“Cholesterol-lowering drugs save lives and prevent heart attacks and should be prescribed to all patients with coronary artery disease,” Dr. Nina Johnston, a study author and cardiologist at Uppsala University in Sweden, said in a press release. “Unfortunately, our study shows that women are missing out on these essential medications.”

“Our findings should be a wake-up call about the under-treatment of women with heart disease,” she added. “Equal prescribing practices are needed so that women receive all recommended therapies and are protected from adverse outcomes.”