Improving Racial and Ethnic Minority Representation in Cardiovascular Disease Trials to Advance Health Equity—Reply

Abstract

To the Editor We read with interest the article by Sparrow et al 1 published in JAMA Cardiology. The authors performed a systematic review of 20 randomized clinical trials published from 2005 to 2019, aimed at increasing statin prescribing for primary cardiovascular disease prevention. Their report described several intervention styles used to improve statin prescribing, including patient education, decision support tools, and audit and feedback. As cardiovascular disease remains the leading cause of mortality in the United States, this study was of great importance.However, we would like to note the limited representation of racial and ethnic minority participants in the trials evaluated in this review. We observed that most studies (15 of 20 [75%]) did not report race or ethnicity. 1 Of the 5 studies that did report, African American individuals were the most common minority group, followed by Hispanic individuals (reported in only 4 studies). Asian race was reported in 1 of 20 studies examined.While not the primary purpose of their review, Sparrow et al 1 remind us of the dearth of intervention studies that address disparities in cardiovascular disease prevention. 2 Possible explanations for this observation include the persistent underrepresentation of racial and ethnic minorities in randomized clinical trials. 3 Second, despite national policy changes to increase insurance coverage in the United States, racial and ethnic differences in access to medical care remain, limiting access to medications, specialist care, and clinic-based research trials. 4 Lastly, there is still incomplete understanding of the role race and ethnicity play in medication prescribing, including the impact of minority patient trust in the health system 5 as well as physician bias in prescribing.As clinical and social cardiovascular disease risk factors rise, there is a critical need to address racial and ethnic minority underrepresentation in intervention-based trials and understand its role in persisting health disparities. A stronger health system engagement with minority communities is just one of several strategies that can be implemented widely to achieve this goal. Furthermore, as evidence-based therapies, such as statins, become more widely available, there is an opportunity for clinicians and researchers to ensure that these medications are offered equitably to all patients. We thank Sparrow et al 1 for their important review and the reminder that there is still much work to be done to advance cardiovascular health equity.