Does African American race reduce guideline-recommended statin use and dosing in outpatient adults eligible for primary or secondary prevention statins?
African American patients are less likely to receive guideline-recommended statin therapy than white patients, with disparities partially explained by differences in patient beliefs regarding statin safety and efficacy, as well as trust in clinicians.
Importance: African American individuals face higher atherosclerotic cardiovascular disease risk than white individuals; reasons for these differences, including potential differences in patient beliefs regarding preventive care, remain unknown. Objective: To evaluate differences in statin use between white and African American patients and identify the potential causes for any observed differences. Design, Setting, and Participants: Using the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data, we compared statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins. A total of 138 US community health care practices contributed to the data. Data analysis was conducted from March 2017 to May 2018. Main Outcomes and Measures: Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs. Poisson regression was used to evaluate the association between race and statin undertreatment, a category combining people who were not taking a statin or those taking a dose intensity lower than recommended. Results: A total of 5689 patients (806 14.2% African American) in the PALM registry were eligible for statin therapy. African American individuals were less likely than white individuals to be treated with a statin (570/807 70.6% vs 3654/4883 74.8%; P = .02). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 33.3% vs 2145 43.9%, respectively; P < .001; relative risk, 1.07 95% CI, 1.00-1.15; P = .05, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 76.0-121.0 mg/dL vs 85.0 68.0-105.0 mg/dL; P < .001). African American individuals were less likely than white individuals to believe statins were safe (292 36.2% vs 2800 57.3%; P < .001) or effective (564 70.0% vs 3635 74.4%; P = .008) and were less likely to trust their clinician (663 82.3% vs 4579 93.8%; P < .001). Group differences in statin undertreatment were not significant after adjusting for demographic, clinical, and clinician factors, socioeconomic status, and patient beliefs (final adjusted relative risk, 1.03 95% CI 0.96-1.11; P = .35). Conclusions and Relevance: African American individuals were less likely to receive guideline-recommended statin therapy. Demographic, clinical, socioeconomic, belief-related, and clinician differences contributed to observed differences and represent potential targets for intervention.
Nanna et al. (Wed,) studied this question.