Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity

Area of Science:

• Cardiology
• Public Health
• Health Disparities Research

Background:

• Atherosclerotic cardiovascular disease (ASCVD) treatment disparities exist across racial and ethnic groups.
• Statins are crucial for reducing low-density lipoprotein cholesterol (LDL-c) and improving ASCVD outcomes.
• Understanding ASCVD treatment patterns within disaggregated racial and ethnic populations is essential.

Purpose of the Study:

• To evaluate statin utilization and LDL-c control in patients with ASCVD, stratified by detailed race and ethnicity categories.
• To identify potential disparities in guideline-directed medical therapy and lipid management post-ASCVD diagnosis.

Main Methods:

• Analysis of an electronic health record (EHR)-based cohort from 2010-2021 in Northern California.
• Inclusion of adult patients with an ASCVD diagnosis and at least two primary care visits.
• Stratification by race/ethnicity (Non-Hispanic White, Non-Hispanic Black, disaggregated Hispanic and Asian groups) and assessment of 1-year post-ASCVD statin use and LDL-c control (<70 mg/dL).

Main Results:

• The cohort comprised 133,158 patients: 89,944 NHW, 6,294 Black, 12,478 Hispanic, and 13,179 Asian.
• Suboptimal statin use (<60% any statin, <25% high-intensity) and LDL-c control (<30% achieving <70 mg/dL) were observed across all groups.
• Black patients exhibited the lowest statin use (46.7%) and LDL-c control (10.7%), with significant within-group heterogeneity noted in Asian and Hispanic populations.

Conclusions:

• Significant and heterogeneous disparities in 1-year post-ASCVD statin use and LDL-c control exist across disaggregated racial and ethnic groups.
• These findings underscore the need for targeted interventions to address inequities in ASCVD care.
• Improved understanding of these disparities can guide implementation strategies for more equitable cardiovascular disease management.