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Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Factors associated with lipid lowering therapy in the multi-ethnic study of atherosclerosis
Jing Cao1, Weihua Guan2, Sarah O Nomura3
1Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Lipid-lowering therapy (LLT) underuse is common. Black participants were less likely to use LLT, but coronary artery calcium (CAC) presence strongly predicted LLT use, suggesting CAC screening can improve guideline adherence.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Disparities
Background:
- Lipid-lowering therapy (LLT) is crucial for managing atherosclerotic cardiovascular disease (ASCVD) risk.
- Significant underuse of LLT affects over 40% of eligible individuals in the US.
- Limited research exists on actionable factors influencing guideline-directed LLT use.
Purpose of the Study:
- To identify factors associated with LLT use among individuals eligible for therapy.
- To explore the role of coronary artery calcium (CAC) in predicting LLT adherence.
- To investigate healthcare disparities in LLT utilization.
Main Methods:
- Analysis of participants from the Multi-Ethnic Study of Atherosclerosis (MESA) qualified for LLT in 2010-2012.
- Categorization of participants into on-LLT or off-LLT groups in 2016-2018.
- Multivariable relative risk (RR) models assessed associations between LLT use and demographic, clinical, and CAC factors.
Main Results:
- Of 2114 eligible participants, 53.4% were on LLT.
- Black participants showed lower LLT use (RR 0.80).
- Diabetes (RR 1.39), hypertension (RR 1.23), and CAC > 0 (RR 1.38) were positively associated with LLT use.
Conclusions:
- Key factors influencing LLT use were identified in the MESA cohort.
- Lower LLT use among Black participants indicates significant healthcare disparities.
- CAC measurement is a strong, actionable predictor for improving LLT guideline adherence.
Background:
Lipid-lowering therapy (LLT) plays a central role in managing atherosclerotic cardiovascular disease (ASCVD) risk, but its underuse is reported in over 40% of the qualified population in the United States. Studies on factors, particularly actionable factors associated with guideline-directed LLT are limited.
Methods:
This study evaluated participants from the Multi-Ethnic Study of Atherosclerosis (MESA) on their qualification for LLT at exam 5 (2010-2012) according to the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on cholesterol management. Participants were categorized as on-LLT or off-LLT at the following exam (2016-2018). Multi-variable relative risk (RR) models were used to analyze between LLT usage and factors prior to 2013, including age, gender, race/ethnicity, education level and medical insurance, income, smoking, body mass index (BMI), diabetes, hypertension, and presence of coronary artery calcium (CAC).
Results:
Among the 2114 participants qualified for LLT at exam 5 with an average age of 70.7, 1,129 (53.4%) were on LLT while 985 (46.6%) were off LLT at exam 6. Black participants were less likely to be on LLT compared to the reference white participants (RR 0.80, 95% confidence interval CI 0.71-0.90). Higher BMI showed borderline significant association with LLT. Comorbidities of diabetes and hypertension were positively associated with LLT use (RR 1.39 and 1.23, 95% CI 1.27-1.52 and 1.10-1.36, respectively). CAC score > 0 as an indicator of subclinical ASCVD was strongly associated with LLT too, independent of other demographic or comorbidity factors (RR 1.38, 95% CI 1.21-1.56).
Conclusions:
This study identifies key factors influencing LLT use among MESA participants. Black participants were less likely to be on LLT, highlighting healthcare disparities. CAC presence was strongly associated with LLT use, suggesting that CAC measurement could be an actionable factor to improve adherence to LLT guidelines.
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