Related Experiment Video
Updated: May 10, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Disparities in statin use following identification of coronary artery calcium
Charlotte C Ellberg1, Kavenpreet Bal2, Edward Duran3
1Department of Medicine, University of California San Diego, La Jolla, CA, USA.
Insights
Coronary artery calcium (CAC) scoring identifies individuals needing statin therapy. However, disparities in statin use exist based on race, language, and social determinants of health (SDOH).
Area of Science:
- Cardiovascular disease research
- Health disparities and social determinants of health
- Preventive cardiology
Background:
- Coronary artery calcium (CAC) scoring aids risk stratification in asymptomatic individuals.
- Clinical practice recommends statin therapy for individuals with identified CAC.
- Health disparities and social determinants of health (SDOH) significantly impact cardiovascular disease (CVD) risk and outcomes.
Purpose of the Study:
- To investigate potential disparities in statin utilization following CAC identification.
- To analyze the association of race/ethnicity, primary language, and SDOH with statin use.
- To evaluate these disparities within the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
Main Methods:
- Logistic regression models were employed to assess associations.
- Adjustments were made for traditional cardiovascular disease risk factors.
- Statin use was evaluated at short- and long-term follow-up in individuals with CAC > 0 and no baseline statin use.
Main Results:
- Hispanic and Spanish-speaking individuals showed lower statin use at short-term follow-up, alongside those with higher SDOH burden.
- Black, Chinese, and Chinese-speaking individuals exhibited reduced statin use at long-term follow-up.
- A trend towards lower statin use was observed with higher SDOH scores at long-term follow-up.
Conclusions:
- Significant disparities in statin use exist post-CAC identification, influenced by race/ethnicity, language, and SDOH.
- While CAC is valuable for detecting atherosclerosis, equitable application of recommended therapies is crucial.
- Addressing these disparities is essential for improving cardiovascular health outcomes across diverse populations.
Background:
Coronary artery calcium (CAC) scoring is a useful tool for risk stratification in asymptomatic individuals, and current clinical practice is to utilize statins in individuals with CAC. A growing body of research has aimed to identify and mitigate health disparities and their relation to cardiovascular disease (CVD) risk. Likewise, studies have highlighted social determinants of health (SDOH) that contribute to health disparities in CVD.
Objectives:
We aimed to evaluate whether disparities exist with regards to statin use after identification of CAC within the Multi-Ethnic Study of Atherosclerosis (MESA).
Methods:
The associations between race/ethnicity, age, sex, primary language, and an aggregate SDOH score (calculated using previously defined methods) with statin use at short- and long-term follow-up were evaluated in logistic regression models with adjustment for traditional CVD risk factors in individuals with baseline CAC>0 without baseline statin use.
Results:
In the overall cohort, 3416 participants had CAC = 0, 1794 CAC 1-99, 757 CAC 100-300, and 847 CAC>300 AU Mean age was 62 (10.2) years, 53 % (n = 3601) were women, 38.5 % (n = 2622) were non-Hispanic White, 27.8 % (n = 1892) were non-Hispanic Black, 22.0 % (n = 1892) were Hispanic and 11.8 % (n = 1892) were Chinese. At short-term follow up (median 1.6 years, n = 2665), those with a higher SDOH score (worse burden) (OR 0.39, 95 % CI 0.16-0.91), Hispanic (OR 0.59, 95 % CI 0.40-0.85) and Spanish speaking individuals (OR 0.51, 95 % CI 0.30-0.83) were less likely to report statin use following CAC identification. At long-term follow up (median 9.4 years, n = 2533), Black individuals (OR 0.71, 95 % CI 0.52-0.96), Chinese (OR 0.58, 95 % CI 0.39-0.86) and Chinese speaking individuals (OR 0.50, 95 % CI 0.33-0.76) were also less likely to report statin use following CAC identification, and a trend was noted for SDOH score (OR 0.53, 95 % CI 0.26-1.09).
Conclusions:
This study identifies disparities in statin use by race/ethnicity, language, and social determinants of health after identification of CAC. While CAC is an effective tool for identifying atherosclerosis in asymptomatic individuals, more equitable use of subsequent therapy is needed.
More Related Videos
06:57Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Related Concept Videos
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...