为什么女性比男性更少服用降胆固醇的他汀类药物?

Women are less likely than men to be treated with cholesterol-lowering statins – or get them prescribed at guideline-recommended intensity levels when they do, 一项新的研究也研究了这种差异背后的原因.

他汀类药物有助于降低心脏病发作的风险, 通过降低高胆固醇水平来预防中风和其他心血管疾病. But women historically have received less aggressive treatment than men when it comes to cholesterol management.

Researchers explored potential causes for the differences in a study published Friday in 循环:心血管质量和结果. 他们检查了5月5日的国家登记数据,693 people eligible for statin treatment based on cholesterol management guidelines from the 美国心脏协会 and American College of Cardiology.

Researchers found women were considerably less likely than men – 67% compared to 78% – to be treated with a statin. 列举的原因包括, 女性不像男性那样经常接受药物治疗, were more likely to decline statin therapy when it was recommended and were more inclined to discontinue the treatment after starting it, 通常会提到副作用.

Women and men had different beliefs about the role of statins in relation to cardiovascular disease, 研究发现. Women were more likely to worry about having a heart attack or stroke – yet less likely to believe that having high cholesterol could contribute to one.

即使在研究人员调整了年龄之后，性别差异仍然存在, 种族和其他人口统计数据, 以及社会经济因素和健康史.

"Patients and providers alike must be educated on the safety and efficacy of statin therapy to optimize therapeutic efforts,研究人员在报告中说.

About 35% of men and 40% of women had total cholesterol levels of 200 mg/dL or higher between 2013 and 2016, 根据美国心脏协会.

"Part of the onus falls on providers doing a better job in communicating the safety and efficacy of these therapies to their patients," said Dr. 迈克尔奶奶, the study's lead author and a cardiology fellow at Duke University's Clinical Research Institute in North Carolina.

More research also is needed to explore why specific medical treatments are not being used and how to influence their acceptance, he said.

"We have invested significant resources into developing safe and effective therapies, but if you look at how often they are prescribed and patients who are taking them, 它是分数," Nanna said. Future efforts should be aimed at improving the use of those therapies, he said.

The report is among a new wave of studies trying to reach beyond data sets and lab findings to uncover reasons for health care differences, said Dr. Prateeti Khazanie, an assistant professor of cardiology at the University of Colorado School of Medicine.

而之前的研究表明，女性比男性更不可能使用他汀类药物, the new study found underlying factors from both patient and provider that contributed to the problem.

“如果你能更好地理解性别差异背后的原因, 你可以针对这些问题来帮助减少未来的性别差异," she said.

"Understanding how therapies affect patients and how patients make decisions – and how providers make decisions – are going to be critical in future research."

Khazanie没有参与这项研究，但与人合作撰写了一篇 随附透视片 that discussed ways a value-based health care system – one in which hospitals and physicians are given incentives based on patient results – could be used to address sex differences in care. 

Treatment discrepancies between men and women in a range of cardiovascular care has been getting more attention, she said. 但人们对其中的原因仍然知之甚少.

一些理论认为，女性表现出的症状与男性不同, 也许他们没有及早被发现,可扎妮说。.

"Many women tend to discount their own symptoms and also have a harder time trusting medical therapies. 不幸的是，这可能是其中很大的一部分。. "This is a really complex and multifactorial topic and future interventions to reduce sex differences in care will require a multipronged approach addressing issues with both clinicians and patients."

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