Racial differences persist in statin use among adults, specifically African American adults, who are less likely to be treated with any statin or guideline-recommended statin intensity compared with white adults, which may contribute to higher LDL-C levels among African American patients, according to a study published in JAMA Cardiology.
Michael G. Nanna, MD, from Duke University Medical Center, in Durham, NC, and colleagues, used the Patient and Provider Assessment of Lipid Management (PALM) registry data to compare statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins.
Data were collected at 138 primary care, cardiology, and endocrinology practices that enrolled patients between May 2015 and November 2015. Patient surveys were conducted to determine self-reported race, education level, socioeconomic status, and beliefs about statins, cholesterol, atherosclerotic cardiovascular disease (ASCVD), and clinician trust. All participants were asked to complete the survey at enrollment (response rate, 95.3%).
Participants were classified as eligible for high-intensity statin therapy per guideline recommendations:
- Patients with clinical ASCVD defined as coronary artery disease (prior myocardial infarction, obstructive coronary artery disease, coronary artery bypass grafting, or percutaneous coronary intervention), cerebrovascular disease (prior transient ischemic attack or stroke), other ASCVD (peripheral arterial disease, abdominal aortic aneurysm, noncoronary arterial revascularization, and carotid stenosis), combined with an age of 75 years or younger;
- Patients with a low-density lipoprotein cholesterol (LDL-C) level of 190 mg/dL or more
- Diabetes with a 10-year ASCVD risk of 7.5% or greater (based on a pooled cohort risk equation), combined with an age of 40 to 75 years and a LDL-C level of 70 mg/dL or more.
The researchers also considered adults aged 40 to 75 years who had diabetes and a predicted 10-year ASCVD risk of 7.5% or higher who were taking a statin at the time of enrollment and were eligible for high-intensity statin therapy, regardless of their LDL-C level.
Statin treatment patterns (not taking a statin, taking lower than appropriate dose of statin, and taking an appropriate dose of statin) were evaluated by race within the overall population and by indication (primary and secondary prevention). Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs.
Of the 7,736 patients in the PALM registry, 5,689 met inclusion criteria (73.5%). Of this group, 806 were African American (14.2%), and 4883 were white (85.8%). Race and ethnicity were both self-reported; 37 of 806 African American patients (4.6%) and 591 of 4,883 white patients (12.1%) self-identified as Hispanic.
African American individuals were less likely than white individuals to be treated with a statin (570/807 [70.6%] vs 3654/4883 [74.8%]). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 [33.3%] vs 2145 [43.9%]; relative risk, 1.07, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 [76.0-121.0] mg/dL vs 85.0 [68.0-105.0] mg/dL).
“Among those individuals who meet criteria for statins in the PALM registry, we found that African American individuals were slightly less likely than white individuals to receive statins overall and much less likely to receive the guideline-recommended statin intensity,” the authors concluded. “African American and white individuals had different perceptions and beliefs regarding statin therapy, which, along with other factors including demographics, clinical characteristics, socioeconomic status, and lower frequency of care by cardiologists, accounted for the differences in treatment observed.”
Nanna MG, Navar AM, Zakroysky P, et al. Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use: Insights from the patient and provider assessment of lipid management registry [published online July 13, 2018]. JAMA Cardiol. doi:10.1001/jamacardio.2018.1511