Inequity, workload, and external factors: a descriptive study on high-intensity statin prescriptions for patients with clinical cardiovascular disease and at high risk for cardiovascular disease

Despite guidelines for statin use to reduce atherosclerotic cardiovascular disease (ASCVD) from the American College of Cardiology and American Heart Association (ACC/AHA) and quality measures from the Centers for Medicare and Medicaid Services (CMS), inconsistencies in guideline adherence persist. While there are studies examining associations of individual factors with statin prescriptions, there is a paucity of literature considering multiple factors. We conducted a cross-sectional, retrospective review of 20,923 medical charts of patients diagnosed with ASCVD, low-density lipoprotein cholesterol (LDL-c) ≥ 190 mg/dL, or ASCVD risk ≥ 20%, aged 40 to 75 years old. Statin prescribing rates were as follows: high-intensity statins (33.7%), low- or medium-intensity statins (33.5%), and no statin (32.8%). Sex significantly affected high-intensity statin prescribing, as 35.2% of men and 30.3% of women received a high-intensity statin (p < 0.0001). Race significantly affected any statin prescribing as 67.4% of White patients, 59.0% of Black patients, and 64.1% of American Indian/Alaska Native patients received any statin prescription (p = 0.0074). The mean age for patients prescribed a high-intensity statin was also significantly lower (64.8 years) than those not (66.6 years) (p < 0.001). Increased number of appointments was statistically significant for increased use of high-intensity statins (p = 0.0001) and any statin (p = 0.0001). Female primary care providers (PCPs) had a prescribing rate of 71.0% while male PCPs had a rate of 68.5% for any statin (p = 0.0005). We found that adherence to ACC/AHA and CMSguidelines remains incomplete and highlights several factors contributing to lower likelihood of statin prescription including patient and PCP demographics.