Racial Disparities in Statin Use for Guideline-Directed ASCVD Prevention

Guideline-recommended statin use for primary atherosclerosis cardiovascular disease (ASCVD) prevention is low, especially among Black and Hispanic adults in the United States (US), according to results of a study published in JAMA Cardiology.

Investigators from University of Utah, Salt Lake City, sourced data for this study from the National Health and Nutrition Examination Survey (NHNES) which is an ongoing cross-sectional survey conducted in the US. This analysis pooled data from between 2013 and 2020 for the study. As previous data has suggested there are racial disparities in statin use, the outcomes of interest in this study were the rates of statin use for the primary prevention of ASCVD among adults aged 40 to 75 years (N=3417) on the basis of race and ethnicity and ASCVD risk stratum.

The study cohort comprised adults with a mean age of 61.8 (SD, 8.0) years. Using a sample weighting approach to project data to represent 39.4 million adults in the US, 37.8% were women, 12.7% were Black, 10.1% were Hispanic, and 4.2% were Asian. The proportion of the population with ASCVD risk of 5% to less than 7.5% was 31.0%, 7.5% to less than 20% was 58.3%, and 20% or greater was 10.7%.

Stratified by race and ethnicity, 10-year ASCVD risk was 10.3% among Black adults, 10.1% among Asian adults, 9.6% among White adults, and 9.2% among Hispanic adults.

The overall prevalence of statin use was 25.5%. Compared with White individuals (27.9%), use of statins was significantly lower among Black (20.0%; P <.001) and Hispanic (15.4%; P <.001) individuals and no different among Asian individuals (25.5%; P =.38).

In general, the rate of statin use increased with ASCVD risk, however, in the highest-risk strata, use of statins remained low among Black (prevalence ratio [PR], 0.90; 95% CI, 0.82-0.98) and Hispanic (PR, 0.90; 95% CI, 0.81-0.99) individuals compared with White individuals.

Stratified by survey wave, the Black and Hispanic groups had lower statin use than the White and Asian groups across all waves. No significant trends were observed over time.

In the 4 race and ethnicity groups, predictors for statin use included having a routine location for healthcare (adjusted PR [aPR] range, 1.17-1.22) and having 20% or greater 10-year ASCVD risk (aPR range, 1.10-1.22). In addition, having health insurance was a predictor for statin use among the Black, Hispanic, and White cohorts (aPR range, 1.14-1.24) and obesity was a predictor among the Asian, Hispanic, and White cohorts (aPR range, 1.07-1.11).

These findings may have been biased by pooling Hispanic and Asian subgroups into single groups, which may have homogenized trends.

These data confirmed there are racial disparities in statin use among adults in the US who are at risk for ASCVD. The study authors concluded, “In the current analysis of NHANES participants from 2013 through March 2020 with a guideline indication for statin use for primary prevention, prevalence of statin use was substantially lower among Black and Hispanic participants compared to White participants. Overall, prevalence of statin use was low among Asian, Black, Hispanic, and White participants, particularly among those with an ASCVD risk 20% or greater.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on The Cardiology Advisor