Many Hispanic Patients Undertreated for High Cholesterol

ORLANDO, Fla. — In a study of more than 16 000 adults, only one-third to one-half of Hispanic patients eligible for cholesterol-lowering therapy were taking statins, according to research presented at the American Heart Association Scientific Sessions.

“Hispanic/Latinos are one of the underprivileged ethnicities of U.S. that is not well studied. Most of the known cohorts include whites, blacks, and at best, Mexicans. They do not have other ethnicities included. This is the first and largest study of this kind that attempted to determine the proportion of Hispanics/Latinos that are eligible under the new 2013 American College of Cardiology/American Heart Association (ACC/AHA) treatment guidelines and the proportion of individuals who are undertreated with statins currently,” said study investigator Waqas Qureshi MD, who is a cardiology fellow at Wake Forest University in Winston-Salem, North Carolina.

Dr Qureshi and colleagues evaluated the need for high cholesterol treatment among 16 415 U.S. Hispanic/Latino adults. They found only 1716 (10.4%) were on statin therapy, which was significantly lower than what would have been expected. The study also showed that 3366 (20.5%) were eligible for statin therapy under National Cholesterol Education Program Adult Treatment Panel (NCEP/ATP III), and 5268 (32.1%) were eligible for the therapy under the 2013 ACC/AHA treatment guidelines.

The proportion of statin-eligible adults increased among older adults according to both recommendations, and among males in the ACC/AHA guidelines, reported Dr Qureshi. There was also an increase in eligibility for statin therapy in middle-aged adults. Regardless of the definition for statin eligibility, Hispanics are largely undertreated, the researchers concluded.

“The clinical implications are 2-fold. First, [there is] knowledge that many of the younger Hispanics are undertreated and secondly Hispanics will need similar strategies to increase statin usage as other ethnicities,” Dr Qureshi told Endocrinology Advisor.

The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a large multicenter study of Hispanics/Latinos in the Bronx, New York, Chicago, Miami, and San Diego. 

The mean age of the participants was 41 years, and 40% were men. The researchers evaluated prevalence of statin-treated individuals and the proportion of adults estimated to meet eligibility for statin therapy under NCEP/ATP III vs 2013 ACC/AHA cholesterol treatment guidelines.

The researchers also found that that the proportion of statin-eligible adults increased primarily among older adults from 44% to 87% under NCEP/ATP III guidelines and in males from 19% to 39% under the 2013 ACC/AHA guidelines. The eligibility of statin therapy almost doubled consistently across all Hispanic/Latino subgroups under the new 2013 ACC/AHA guidelines, said Dr Qureshi.

Statin therapy is recommended for primary prevention of atherosclerotic cardiovascular disease. Hispanics/Latinos are the largest ethnic minority in United States with significant cultural and racial heterogeneity, according to Dr Qureshi, who noted that until now, there has been little research into whether the newer cholesterol guidelines have increased or decreased the eligibility of statin therapy for U.S. Hispanics/Latinos.

The study suggests that there may be several reasons for the undertreatment of Hispanics/Latinos with statin therapy despite being eligible for them, the researchers concluded.

Dr Qureshi said that he hopes these study findings lead to further investigations into how best to address this issue of undertreatment.

“For endocrinologists managing hyperlipidemias, it is important to understand that the new guidelines are likely to increase the proportion of individuals that should be treated with statins. However, due to published literature suggesting higher risk of diabetes with statins, it is likely that Hispanics which are more prone to diabetes might be affected disproportionately with increased statin use. Surveillance of diabetes and other side effects should be continued in these individuals,” concluded Dr Qureshi.

Reference

1. Qureshi WT. M 2146 – ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk: Implications for US Hispanics/Latino Based on Findings From the HCHS-SOL. Presented at the American Heart Association Scientific Sessions; November 7-11, 2015; Orlando, FL.