ImportanceThe burden of atherosclerotic cardiovascular disease (ASCVD) in the US is higher among Black and Hispanic vs White adults. Inclusion of race in guidance for statin indication may lead to decreased disparities in statin use.ObjectiveTo evaluate prevalence of primary prevention statin use by race and ethnicity according to 10-year ASCVD risk.Design, Setting, and ParticipantsThis serial, cross-sectional analysis performed in May 2022 used data from the National Health and Nutrition Examination Survey, a nationally representative sample of health status in the US, from 2013 to March 2020 (limited cycle due to the COVID-19 pandemic), to evaluate statin use for primary prevention of ASCVD and to estimate 10-year ASCVD risk. Participants aged 40 to 75 years without ASCVD, diabetes, low-density lipoprotein cholesterol levels 190 mg/dL or greater, and with data on medication use were included.ExposuresSelf-identified race and ethnicity (Asian, Black, Hispanic, and White) and 10-year ASCVD risk category (5%-<7.5%, 7.5%-<20%, ≥20%).Main Outcomes and MeasuresPrevalence of statin use, defined as identification of statin use on pill bottle review.ResultsA total of 3417 participants representing 39.4 million US adults after applying sampling weights (mean [SD] age, 61.8 [8.0] years; 1289 women [weighted percentage, 37.8%] and 2128 men [weighted percentage, 62.2%]; 329 Asian [weighted percentage, 4.2%], 1032 Black [weighted percentage, 12.7%], 786 Hispanic [weighted percentage, 10.1%], and 1270 White [weighted percentage, 73.0%]) were included. Compared with White participants, statin use was lower in Black and Hispanic participants and comparable among Asian participants in the overall cohort (Asian, 25.5%; Black, 20.0%; Hispanic, 15.4%; White, 27.9%) and within ASCVD risk strata. Within each race and ethnicity group, a graded increase in statin use was observed across increasing ASCVD risk strata. Statin use was low in the highest risk stratum overall with significantly lower rates of use among Black (23.8%; prevalence ratio [PR], 0.90; 95% CI, 0.82-0.98 vs White) and Hispanic participants (23.9%; PR, 0.90; 95% CI, 0.81-0.99 vs White). Among other factors, routine health care access and health insurance were significantly associated with higher statin use in Black, Hispanic, and White adults. Prevalence of statin use did not meaningfully change over time by race and ethnicity or by ASCVD risk stratum.Conclusions and RelevanceIn this study, statin use for primary prevention of ASCVD was low among all race and ethnicity groups regardless of ASCVD risk, with the lowest use occurring among Black and Hispanic adults. Improvements in access to care may promote equitable use of primary prevention statins in Black and Hispanic adults.

BACKGROUND: Despite evidence supporting the cardiovascular and cognitive benefits of intensive blood pressure management, older adults have the lowest rates of blood pressure control. We determined the association between age and therapeutic inertia (TI) in SPRINT (Systolic Blood Pressure Intervention Trial), and whether frailty, cognitive function, or gait speed moderate or mediate these associations. METHODS: We performed a secondary analysis of SPRINT of participant visits with blood pressure above randomized treatment goal. We categorized baseline age as <60, 60 to <70, 70 to <80, and ≥80 years and TI as no antihypertensive medication intensification per participant visit. Generalized estimating equations generated odds ratios for TI associated with age, stratified by treatment group based on nested models adjusted for baseline frailty index score (fit [frailty index, ≤0.10], less fit [0.10<frailty index≤0.21], and frail [0.21<frailty index]), cognitive function by Montreal cognitive assessment, and gait speed (participants ≥75 years of age), separately. RESULTS: Participants 60 to <70, 70 to <80, and ≥80 years of age had a higher prevalence of TI in both treatment groups versus participants <60 years of age (standard: 59.7%, 60.5%, and 60.1% versus 56.0%; 29 527 participant visits; intensive: 55.1%, 57.2%, and 57.8% versus 53.8%; 47 129 participant visits). The adjusted odds ratios for TI comparing participants ≥80 versus <60 years of age were 1.32 (95% CI, 1.14–1.53) and 1.25 (95% CI, 1.11–1.41) in the standard and intensive treatment groups, respectively. Adjustment for frailty, cognitive function, or gait speed did not attenuate the association or demonstrate effect modification (all P interaction , >0.10). CONCLUSIONS: Older age is associated with greater TI independent of physical or cognitive function, implying age bias in hypertension management.

Introduction: The burden of ASCVD is higher among non-Hispanic Black (NHB) and Hispanic vs. non-Hispanic White (NHW) US adults, potentially due to differences in use of preventive medications such as statins. We evaluated patterns in statin use for primary prevention by self-identified race/ethnicity (NHB, NHW, and Hispanic) according to 10-year ASCVD risk using the Pooled Cohort Equations. Methods: This serial, cross-sectional analysis included NHANES participants from 2013-2020 age 40-75 years without ASCVD, diabetes, LDL ≥190 mg/dL, or missing data for estimation of 10-year ASCVD risk. Statin use was determined by interviewer pill bottle review. Poisson regression estimated adjusted prevalence ratios for statin use associated with race/ethnicity and ASCVD risk categories (5-<7.5%, 7.5-<20%, and ≥20%); all analyses incorporated NHANES survey weights. Results: A total of 3,088 participants representing 37.8 million US adults (mean age 62 y, 38% women, 13% NHB, 11% Hispanic, 76% NHW) were included. Overall, statin use was lower in NHB (20.0%) and Hispanic (15.4%) than NHW adults (27.9%). Within all ASCVD risk categories, the odds of statin use were significantly lower among NHB and Hispanic vs. NHW adults (Figure). Within each race/ethnicity group, the use of statins increased across increasing ASCVD risk strata, with a significantly greater utilization among those with ASCVD risk ≥20% (vs. ASCVD risk 5-<7.5%) (Figure). Statin use was stable over time and within race/ethnicity and risk strata (p>0.05 for all NHANES cycles). Conclusions: Overall statin use for primary prevention based on 10-year ASCVD risk was low in all race/ethnicity groups regardless of predicted ASCVD risk, though undertreatment was most severe in NHB and Hispanic adults. Improvements in equitable utilization of statins for primary prevention in Black and Hispanic adults are needed to address disparities in ASCVD.