Cardiovascular disease (CVD) is the leading cause of death in men and women worldwide. Meta-analyses of the Cholesterol Treatment Trialists’ (CTT) Collaboration database have shown the importance of lipid lowering in women.1,2 Women taking statins for both primary and secondary prevention experienced a reduction in major cardiovascular events and all-cause mortality that was similar to men. Both the use of LLT and achievement of optimal LDL-C levels have historically been suboptimal in women when compared to men and gaps in lipid treatment have been found in both claims data and registry data.3 Although statins are the first-line lipid lowering therapy to reduce cardiovascular risk, gender-based disparities in prescription patterns and treatment adherence persist. Multiple studies have shown that while women have higher baseline levels of total cholesterol and LDL-C, they are less likely to be prescribed statins or other LLT.4,5 Women with established ASCVD who are treated with statins are less likely than men to achieve target LDL-C levels even when adjusted for LLT intensity, age, ASCVD risk, and social factors.6 Female patients are more likely to experience worse outcomes after acute cardiovascular events and gender disparities have been noted in the initiation of statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors following myocardial infarction.7,8

The causes for gender differences in LLT prescription patterns and LDL-C goal attainment are not fully understood. The Patient and Provider Assessment of Lipid Management (PALM) Registry showed that women were less likely to receive statins for both primary and secondary prevention, even after adjusting for socioeconomic and clinical factors.9 These gaps may be attributed to both patient factors (e.g., biological differences, patient beliefs), provider factors (e.g. unconscious provider bias), and system factors (high patient volume, challenges in recognizing gaps in care and EHR limitations).9,10 To reduce the burden of ASCVD in the general population, it is necessary to better understand why these disparities in care exist for women. In the current retrospective study, we aim to investigate gender differences in lipid measurement, optimal LDL-C attainment, and the potential influence of provider gender on prescribing practices within our health system.