Effects of Race on Statin Prescribing for Primary Prevention With High Atherosclerotic Cardiovascular Disease Risk in a Large Healthcare System

Abstract

BackgroundAlthough guidelines recommend statins with a high level of evidence for 4 primary prevention benefit groups, prescribing disparities still exist. The objective of this study was to evaluate the effects of race on statin prescribing for primary prevention.Methods and ResultsA retrospective cohort analysis of patients within a large academic health system was performed to investigate statin prescribing among primary prevention groups. The statin benefits groups were patients diagnosed with diabetes mellitus, with an low‐density lipoprotein ≥190 mg/dL, or with an atherosclerotic cardiovascular disease (ASCVD) 10‐year risk ≥7.5%. Statin prescribing was 20% in the ASCVD ≥7.5% group, followed by 37.8% in the low‐density lipoprotein ≥190 mg/dL group and 40.5% in the diabetes mellitus group. Blacks were less likely to be prescribed a statin compared with whites in the diabetes mellitus (odds ratio, 0.64; 95% CI, 0.49–0.82; P=0.001) and ASCVD ≥7.5% groups (odds ratio, 0.38; 95% CI, 0.26–0.54; P<0.0001). Blacks 60 to 69 years of age (odds ratio, 7.97; 95% CI, 3.14–20.2; P=0.003) and 70 to 79 years of age (odds ratio, 4.21; 95% CI, 1.81–9.79; P=0.008) were more likely to be prescribed a statin compared with blacks <60 years of age in the ASCVD ≥7.5% group.ConclusionsBlacks are less likely to be prescribed statins in diabetes mellitus and ASCVD ≥7.5% groups compared with whites. Younger blacks with ASCVD risk ≥7.5% are less likely to be prescribed statins compared with older blacks. Future research should focus on tailored interventions to address statin prescribing disparities in blacks.

Is race or ethnicity associated with under‐utilization of statins among women in the United States: The study of women's health across the nation

“…Despite evidence‐based recommendations, several studies have observed statin use among women with CVD to be significantly lower than compared to men with CVD 10,13,19‐22 . Although SWAN did not include men, the rates of statin use among women with CVD, were similar to several other studies 23‐28 . Data from the medical expenditure panel survey (MEPS) demonstrated modestly higher rates of statin use among adults with ASCVD as of 2012 to 2013 compared to those of the SWAN women (58.1% vs 49.6%, respectively) 24 .…”

Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population

“…In particular, younger black patients were less likely to be on an appropriate statin, especially when the sole indication was a 10-year ASCVD risk score of ≥7.5%. Health disparities in black patients with CVD have previously been demonstrated in several studies [ 6 , 10 , 11 ]. Dorsch et al conducted a retrospective study in 2019 with over 9000 participants which showed statin underprescription in younger black patients when compared with majority white patients.…”

“…For example, racial and ethnic minorities and patients with socioeconomic barriers to healthcare face disparities that result in worse outcomes and higher mortality rates secondary to ASCVD [ 5 ]. Younger black patients are particularly vulnerable to these disparities in statin prescription patterns [ 6 ]. This effect of age and race on statin prescription, compounded by a general delay in the adoption of new guidelines by healthcare providers, leads to suboptimal patient care in these populations [ 7 ].…”

Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population

“…Health disparities in Black patients with CVD have previously been demonstrated in several studies. 6,10,11 Dorsch et al conducted a retrospective study in 2019 with over 9000 participants which showed statin underprescription in younger Black patients when compared with majority White patients. Similarly, the PALM (Patient and Provider Assessment of Lipid Management) registry found that Black patients were underprescribed statins across multiple specialties when compared to White patients and the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study cited lower rates of statin use by Black patients living in poverty who lacked health insurance.…”

“…5 Younger Black patients are particularly vulnerable to these disparities in statin prescription patterns. 6 All rights reserved. No reuse allowed without permission.…”