Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity
Objective: There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | American Journal of Preventive Cardiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667724000151 |
| _version_ | 1827304248324390912 |
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| author | Ashish Sarraju Xiaowei Yan Qiwen Huang Ramzi Dudum Latha Palaniappan Fatima Rodriguez |
| author_facet | Ashish Sarraju Xiaowei Yan Qiwen Huang Ramzi Dudum Latha Palaniappan Fatima Rodriguez |
| author_sort | Ashish Sarraju |
| collection | DOAJ |
| description | Objective: There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We aimed to evaluate statin use and LDL-c control for ASCVD by race and ethnicity. Methods: From an electronic health record (EHR)-based cohort from a multisite Northern California health system, we included adults with an ASCVD diagnosis from 2010 to 2021 and at least 2 primary care visits, stratified by race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [Black], Hispanic, and Asian). Hispanic (Mexican, Puerto Rican, Other) and Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other) groups were disaggregated. Primary outcomes were 1-year post-ASCVD statin use (prescription) and LDL-c control (at least one value <70 mg/dL). Adjusted odds ratios (ORs) were estimated using logistic regression. Results: Of 133,158 patients, there were 89,944 NHW, 6,294 Black, 12,478 (9.4 %) Hispanic and 13,179 (9.9 %) Asian patients. At 1 year after incident ASCVD, there was suboptimal statin use (any statins <60 %, high-intensity <25 %) and LDL-c control (<30 %) across groups, with lowest proportions in Black patients for statin use (46.7 %, any statin) and LDL-c control (10.7 %, OR 0.89 (0.81–0.97), referent NHW). Disaggregation of Asian and Hispanic groups unmasked within-group heterogeneity. Conclusions: In patients with incident ASCVD, we describe suboptimal and heterogenous 1-year post-ASCVD guideline-directed statin use and 1-year post-ASCVD LDL-c control across disaggregated race and ethnicity groups. Findings may improve understanding of ASCVD treatment disparities and guide implementation. |
| first_indexed | 2024-04-24T17:26:37Z |
| format | Article |
| id | doaj.art-17832882cefa4497a0eb0624bb405b92 |
| institution | Directory Open Access Journal |
| issn | 2666-6677 |
| language | English |
| last_indexed | 2024-04-24T17:26:37Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj.art-17832882cefa4497a0eb0624bb405b922024-03-28T06:39:13ZengElsevierAmerican Journal of Preventive Cardiology2666-66772024-03-0117100647Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicityAshish Sarraju0Xiaowei Yan1Qiwen Huang2Ramzi Dudum3Latha Palaniappan4Fatima Rodriguez5Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USACenter for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USACenter for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USADivision of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USADivision of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USADivision of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA; Corresponding author at: Center for Academic Medicine, Department of Medicine/Division of Cardiovascular Medicine, Mail Code 5687, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA.Objective: There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We aimed to evaluate statin use and LDL-c control for ASCVD by race and ethnicity. Methods: From an electronic health record (EHR)-based cohort from a multisite Northern California health system, we included adults with an ASCVD diagnosis from 2010 to 2021 and at least 2 primary care visits, stratified by race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [Black], Hispanic, and Asian). Hispanic (Mexican, Puerto Rican, Other) and Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other) groups were disaggregated. Primary outcomes were 1-year post-ASCVD statin use (prescription) and LDL-c control (at least one value <70 mg/dL). Adjusted odds ratios (ORs) were estimated using logistic regression. Results: Of 133,158 patients, there were 89,944 NHW, 6,294 Black, 12,478 (9.4 %) Hispanic and 13,179 (9.9 %) Asian patients. At 1 year after incident ASCVD, there was suboptimal statin use (any statins <60 %, high-intensity <25 %) and LDL-c control (<30 %) across groups, with lowest proportions in Black patients for statin use (46.7 %, any statin) and LDL-c control (10.7 %, OR 0.89 (0.81–0.97), referent NHW). Disaggregation of Asian and Hispanic groups unmasked within-group heterogeneity. Conclusions: In patients with incident ASCVD, we describe suboptimal and heterogenous 1-year post-ASCVD guideline-directed statin use and 1-year post-ASCVD LDL-c control across disaggregated race and ethnicity groups. Findings may improve understanding of ASCVD treatment disparities and guide implementation.http://www.sciencedirect.com/science/article/pii/S2666667724000151RaceEthnicityStatinASCVD, Disparities |
| spellingShingle | Ashish Sarraju Xiaowei Yan Qiwen Huang Ramzi Dudum Latha Palaniappan Fatima Rodriguez Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity American Journal of Preventive Cardiology Race Ethnicity Statin ASCVD, Disparities |
| title | Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity |
| title_full | Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity |
| title_fullStr | Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity |
| title_full_unstemmed | Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity |
| title_short | Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity |
| title_sort | patterns and gaps in guideline directed statin use for atherosclerotic cardiovascular disease by race and ethnicity |
| topic | Race Ethnicity Statin ASCVD, Disparities |
| url | http://www.sciencedirect.com/science/article/pii/S2666667724000151 |
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