Rahul Rege MD, Spencer Weintraub MD, Benjamin Hirsh MD, Christian Leung MD
{"title":"不同性别在开具 SGLT2 抑制剂处方方面的差异","authors":"Rahul Rege MD, Spencer Weintraub MD, Benjamin Hirsh MD, Christian Leung MD","doi":"10.1016/j.jacl.2024.04.044","DOIUrl":null,"url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>In recent years, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in both cardiovascular and renal outcomes, which has resulted in increased provider utilization and inclusion into society guidelines. As the use of SGLT2i expands, variations in prescribing practices may arise.</p></div><div><h3>Objective/Purpose</h3><p>To identify variations in prescribing practices in SGLT2i among patients of different sex with either congestive heart failure (CHF) or chronic kidney disease (CKD).</p></div><div><h3>Methods</h3><p>A cross-sectional analysis of all patients prescribed SGLT2i between 2018 and 2023 within the Northwell Health system in New York State was conducted. Demographic data, including race, sex, ICD-10 codes for CHF and CKD, and last documented GFR, were retrieved from the electronic medical record. Patients were considered to have CKD with an appropriate indication for SGLT2i if they had an ICD-10 code for CKD or a GFR between 30 and 60. This data was then compared to the prevalence of CHF and CKD in men and women as reported in the Medicare Current Beneficiaries Survey (MCBS) of Fall 2021.</p></div><div><h3>Results</h3><p>From 2018 to 2023, of the 11,290 patients were prescribed SGLT2i, 12.7% had CHF and 10.5% had CKD. Of the patients with CHF, 27.6% were women, and of the patients with CKD, 33.9% were women. Within MCBS, women comprised 48.9% of patients with CHF and 51.9% of patients with CKD.</p></div><div><h3>Conclusions</h3><p>While according to MCBS, CHF and CKD affect men and women in approximately equal proportions, our data suggests that less women were prescribed SGLT2i. This discrepancy may represent different prevalence of CHF and CKD in men and women in New York State, contraindications to SGLT2i that are more likely to be present in women, or a systematic bias. Alternatively, prescribers may be hesitant to prescribe SGLT2i to women, given the FDA warning regarding increased risk of genitourinary infections. Ultimately, this study reveals a potential underlying bias in prescribing practices for SGLT2i between men and women that would benefit from further study and enhanced clinician awareness.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Page e515"},"PeriodicalIF":3.6000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Discrepancies in Prescribing Practices for SGLT2 Inhibitors Between Sexes\",\"authors\":\"Rahul Rege MD, Spencer Weintraub MD, Benjamin Hirsh MD, Christian Leung MD\",\"doi\":\"10.1016/j.jacl.2024.04.044\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background/Synopsis</h3><p>In recent years, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in both cardiovascular and renal outcomes, which has resulted in increased provider utilization and inclusion into society guidelines. As the use of SGLT2i expands, variations in prescribing practices may arise.</p></div><div><h3>Objective/Purpose</h3><p>To identify variations in prescribing practices in SGLT2i among patients of different sex with either congestive heart failure (CHF) or chronic kidney disease (CKD).</p></div><div><h3>Methods</h3><p>A cross-sectional analysis of all patients prescribed SGLT2i between 2018 and 2023 within the Northwell Health system in New York State was conducted. Demographic data, including race, sex, ICD-10 codes for CHF and CKD, and last documented GFR, were retrieved from the electronic medical record. Patients were considered to have CKD with an appropriate indication for SGLT2i if they had an ICD-10 code for CKD or a GFR between 30 and 60. This data was then compared to the prevalence of CHF and CKD in men and women as reported in the Medicare Current Beneficiaries Survey (MCBS) of Fall 2021.</p></div><div><h3>Results</h3><p>From 2018 to 2023, of the 11,290 patients were prescribed SGLT2i, 12.7% had CHF and 10.5% had CKD. Of the patients with CHF, 27.6% were women, and of the patients with CKD, 33.9% were women. Within MCBS, women comprised 48.9% of patients with CHF and 51.9% of patients with CKD.</p></div><div><h3>Conclusions</h3><p>While according to MCBS, CHF and CKD affect men and women in approximately equal proportions, our data suggests that less women were prescribed SGLT2i. This discrepancy may represent different prevalence of CHF and CKD in men and women in New York State, contraindications to SGLT2i that are more likely to be present in women, or a systematic bias. Alternatively, prescribers may be hesitant to prescribe SGLT2i to women, given the FDA warning regarding increased risk of genitourinary infections. Ultimately, this study reveals a potential underlying bias in prescribing practices for SGLT2i between men and women that would benefit from further study and enhanced clinician awareness.</p></div>\",\"PeriodicalId\":15392,\"journal\":{\"name\":\"Journal of clinical lipidology\",\"volume\":\"18 4\",\"pages\":\"Page e515\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of clinical lipidology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1933287424000916\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical lipidology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1933287424000916","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
Discrepancies in Prescribing Practices for SGLT2 Inhibitors Between Sexes
Background/Synopsis
In recent years, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in both cardiovascular and renal outcomes, which has resulted in increased provider utilization and inclusion into society guidelines. As the use of SGLT2i expands, variations in prescribing practices may arise.
Objective/Purpose
To identify variations in prescribing practices in SGLT2i among patients of different sex with either congestive heart failure (CHF) or chronic kidney disease (CKD).
Methods
A cross-sectional analysis of all patients prescribed SGLT2i between 2018 and 2023 within the Northwell Health system in New York State was conducted. Demographic data, including race, sex, ICD-10 codes for CHF and CKD, and last documented GFR, were retrieved from the electronic medical record. Patients were considered to have CKD with an appropriate indication for SGLT2i if they had an ICD-10 code for CKD or a GFR between 30 and 60. This data was then compared to the prevalence of CHF and CKD in men and women as reported in the Medicare Current Beneficiaries Survey (MCBS) of Fall 2021.
Results
From 2018 to 2023, of the 11,290 patients were prescribed SGLT2i, 12.7% had CHF and 10.5% had CKD. Of the patients with CHF, 27.6% were women, and of the patients with CKD, 33.9% were women. Within MCBS, women comprised 48.9% of patients with CHF and 51.9% of patients with CKD.
Conclusions
While according to MCBS, CHF and CKD affect men and women in approximately equal proportions, our data suggests that less women were prescribed SGLT2i. This discrepancy may represent different prevalence of CHF and CKD in men and women in New York State, contraindications to SGLT2i that are more likely to be present in women, or a systematic bias. Alternatively, prescribers may be hesitant to prescribe SGLT2i to women, given the FDA warning regarding increased risk of genitourinary infections. Ultimately, this study reveals a potential underlying bias in prescribing practices for SGLT2i between men and women that would benefit from further study and enhanced clinician awareness.
期刊介绍:
Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.