Gender disparities in statin prescriptions in people with HIV with low/moderate to high cardiovascular risk. Open Forum Infectious Diseases
Abela et al. aimed to explore whether gender and ethnicity influence statin prescriptions for cardiovascular disease (CVD) prevention in people with HIV in Switzerland, a high-income country with a high standard of care and more equitable access compared to countries such as the United States—where health insurance significantly impacts medication prescriptions.
The authors computed the CVD risk at each follow-up visit using SCORE2 for participants between ages 40 and 70 years, and SCORE2-OP for participants aged >70 years of age, as recommended by the most recent EACS guidelines. They included d in the analysis participants who were not receiving a statin and whose first CVD risk score in a given category (low/moderate, high, or very high) occurred after 2015, when the systematic collection of co-medications started in the SHCS.
Statins were not commonly prescribed in the low/moderate and high-risk categories, with respectively 7.9% and 13.7% of SHCS participants receiving a statin prescription at some point following the risk assessment. Statin prescriptions were higher in people at very high CVD risks versus those at low/moderate and high risk, with 29.4% of them receiving a statins prescription at some point after the risk assessment. They found no significant differences in statin prescription between people of White and Black ethnicity across all CVD risk categories. Importantly, among people with a low/moderate and high CVD risk, cisgender women were less likely to be prescribed a statin compared to cisgender men, with adjusted hazard ratio of 0.47 (0.31-0.72) and 0.53 (0.37-0.75), respectively. However, in the very high CVD risk category, there were no significant gender-related prescription differences.
In conclusion, the study findings provide opportunities to address inequalities in CVD management across gender in people with HIV and ensure equal access to adequate treatments. Given the REPRIEVE results, the ideal strategy for prescribing statins in primary prevention needs to be defined in clinical care. Efforts are needed to ensure a good communication between clinicians and people with HIV to ensure that people at risk initiate therapy. Finally, further research is needed to understand the gender gap in statin prescription and to develop methods to address it.