22 Apr VA Study Finds Cardiovascular Health Care Disparities Among Young, Female Veterans
MedicalResearch.com Interview with:
Michelle Lee, MD, PharmD
Fellow-in-training, Health Services Research & Development
Michael E. DeBakey VA Medical Center, Houston, TX
Senior & Corresponding Author
Salim S. Virani, MD, PhD, FACC, FAHA, FASPC
Professor, Section of Cardiovascular Research
Director, Cardiology Fellowship Training Program
Baylor College of Medicine
Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center
Co-Director, VA Advanced Fellowship in Health Services Research & Development Michael E. DeBakey VA Medical Center, Houston, TX
Investigator, Health Policy, Quality and Informatics Program
Michael E. DeBakey Veterans Affairs Medical Center HSR&D Center of Innovation
MedicalResearch.com: What is the background for this study?
Response: Atherosclerotic cardiovascular disease (ASCVD), defined as ischemic heart disease (IHD), ischemic cerebrovascular disease (ICVD), or peripheral arterial disease (PAD), is the leading cause of death globally. Particularly in young ASCVD patients, secondary prevention with antiplatelet therapy and statins are extremely important in reducing disease burden.
MedicalResearch.com: What are the main findings?
Response: In this study, we found that women Veterans with premature and extremely premature ASCVD receive less optimal secondary prevention cardiovascular care in comparison to men. Women with premature IHD were also less statin adherent.
MedicalResearch.com: What should readers take away from your report?
Response: Secondary prevention care disparities were seen across all ASCVD patients age ≤55 years. Both men and women with premature and extremely premature ASCVD experienced suboptimal antiplatelet use, statin use, and statin adherence. Moreover, in comparison to men, young women were significantly less likely to receive antiplatelets, any statin, or high-intensity statins.
Reasons for such differences are multi-factorial, relating to clinician and patient factors. Non-prescription of guideline-directed secondary prevention could be partly due to therapeutic inertia among clinicians in aggressively treating young patients with ASCVD particularly young women. Also, patient reluctance to therapy may be attributed to fear of statin-associated side effects, particularly teratogenicity concerns among young women.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research should focus on multidisciplinary and patient-centered interventions and examine barriers in cardiovascular health care delivery among young patients, particularly women of child-bearing age. First, research efforts will be needed to identify potential healthcare delivery gaps. Next, system-level interventions are needed to improve guideline-concordant use of antiplatelet and statin therapy (particularly high-intensity statin therapy) for premature ASCVD patients.
MedicalResearch.com: Is there anything else you would like to add?
Response: It is important to recognize that cardiovascular care disparities adversely affect young patients ≤55 years of age, particularly women. Due to their younger age, under-recognition of ASCVD and false perceptions of low recurrence risk have led to “clinical therapeutic inertia.” This phenomenon results in diagnostic inattentiveness, with higher thresholds to initiate or escalate necessary care. Complacency in secondary cardiovascular prevention in this young cohort may cause devastating long-term consequences with poorer quality-of-life.
Dr. Salim S. Virani reports the following disclosures:
Research support: Department of Veterans Affairs, World Heart Federation, Tahir and Jooma Family.
Honorarium: American College of Cardiology (Associate Editor for Innovations, acc.org)
Lee MT, Mahtta D, Ramsey DJ, et al. Sex-Related Disparities in Cardiovascular Health Care Among Patients With Premature Atherosclerotic Cardiovascular Disease. JAMA Cardiol. Published online April 21, 2021. doi:10.1001/jamacardio.2021.0683
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