A study in JAMA Cardiology reported low utilization rates of statins for the prevention of cardiovascular disease in Black and Hispanic adults in the US. Rates of statin use also have not improved over time.
Statins For Prevention of ASCVD
Statins, or HMG-CoA reductase inhibitors, can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood and are recommended as a primary prevention for atherosclerotic cardiovascular disease (ASCVD) in patients with certain cardiovascular risk factors. In addition to the safety and effectiveness of statins, there are low-cost generic options available. Therefore, the widespread use of statin therapy could potentially have a long-term impact on the burden of cardiovascular disease in the US.
Given the availability and effectiveness of statin therapy, real-world data is needed regarding the rates of initiation and availability of this therapy—particularly in Black and Hispanic patients—who have a higher burden of ASCVD in the US. In the new JAMA study, Dr. Joshua A. Jacobs and colleagues conducted a cross-sectional analysis to investigate the use of statins across racial and ethnic groups in the US.
The main outcome was the prevalence of primary preventative statin use according to 10-year ASCVD risk, compared between Asian, Black, Hispanic, and White participants. ASCVD risk was categorized as 5-<7.5%, 7.5-<20%, and ≥20%. The analysis used data from the National Health and Nutrition Examination Survey, a nationally representative sample of health status. Data was collected from 2013-March 2020. The population of interest included adults aged 40-75 years without ASCVD or diabetes who had low-density lipoprotein cholesterol levels of 190 mg/dL or greater and data on medication use.
A total of 3417 participants were included, representing 39.4 million adults after applying sampling weights. The mean age was 61.8 years, and 37.8% of participants were female. Regarding racial/ethnic demographics, there were 329 Asian participants (weighted percentage, 4.2%), 1032 Black participants (12.7%), 786 Hispanic participants (10.1%), and 1270 White participants (73.0%).
Statin Use in Black and Hispanic Adults
The analysis showed lower utilization rates of statin therapy among Black and Hispanic participants compared with White participants (20.0% and 15.4% vs. 27.9%, respectively). Statin use was comparable between White and Asian participants (25.5%). There was a graded increase in the use of statins across increasing ASCVD risk strata in all racial and ethnic groups. The prevalence of statin use did not significantly change over time by race/ethnicity or by ASCVD risk.
Overall, statin use was low in the highest-risk stratum, and this rate was significantly lower among Black or Hispanic individuals (23.8% and 23.9%, respectively). In this highest-risk group, the prevalence ratio of statin use compared with White participants was 0.9 for both Black and Hispanic participants.
The researchers also assessed non-patient factors associated with statin use. They reported that routine health care access (defined as having seen any clinician within the previous 12 months) and health insurance were significantly associated with greater statin use in Black, Hispanic, and White adults. Eighty-nine percent of Black participants in the highest-risk group had routine health care access, as well as 85% of Hispanic and 95% of White participants. Improving access to care may help close the gap in the use of primary prevention statins, the authors noted, including community-based care.
“There needs to be more targeted therapies, not necessarily from just clinicians or just patients, but a comprehensive group of patients, clinicians, policymakers, to really target these health disparities that are pervasive,” Dr. Jacobs told CNN.
