Black-White Cardiovascular Disease Disparities After Target-Based Versus Personalized Benefit-Based Lipid and Blood...

Area of Science:

• Cardiovascular Medicine
• Health Disparities
• Preventive Cardiology

Background:

• Cardiovascular disease (CVD) is a primary driver of health disparities between Black and White populations in the US.
• Existing treatment guidelines often focus on achieving specific targets for blood pressure and lipid levels.

Purpose of the Study:

• To compare the effectiveness of two treatment strategies for CVD prevention: treat-to-target (TTT) and benefit-based tailored treatment (BTT).
• To assess the impact of these strategies on reducing CVD event rates and the black-white disparity in CVD events.

Main Methods:

• A microsimulation model was used to simulate statin and blood pressure treatment effects.
• Data from the National Health and Nutrition Examination Survey (NHANES) were utilized for adults aged 40-75 without prior CVD events.
• Two approaches were modeled: TTT (using Joint National Commission 7 and Adult Treatment Panel III criteria) and BTT (targeting individuals with a 10-year CVD risk of ≥10%).

Main Results:

• The BTT approach prevented more CVD events per 1,000 individuals (25.9 for Whites, 45.4 for Blacks) compared to TTT (17.0 for Whites, 22.2 for Blacks).
• BTT reduced the black-white CVD event rate disparity by 84% (to 3.6 excess events per 1,000 Blacks), whereas TTT reduced it by 23% (to 17.9 excess events per 1,000 Blacks).
• These findings remained consistent across sensitivity analyses, including alternative treatment targets and risk prediction variations.

Conclusions:

• A benefit-based tailored treatment (BTT) strategy is superior to a traditional treat-to-target (TTT) approach for preventing cardiovascular events.
• BTT demonstrates a significantly greater potential for reducing the black-white disparity in cardiovascular disease events in the United States.