Women, underrepresented populations less likely to receive statins

Key takeaways:

• Disparities in statin use for the prevention of atherosclerotic CVD were not explained by disease severity or access to care.
• Researchers highlighted a need for interventions to address inequitable care.

Researchers found a lower prevalence of statin use for primary and secondary atherosclerotic CVD prevention among nonwhite and female patients, which they said may be partially due to factors such as bias and stereotyping.

David A. Frank, MPH, a student in the department of epidemiology at the University of Pittsburgh Center for Pharmaceutical Policy and Prescribing, and colleagues wrote in Annals of Internal Medicine that statins are a “mainstay” for primary and secondary prevention of atherosclerotic CVD (ASCVD).

Despite statins’ prominent role, the researchers noted that statin rates for ASCVD are unfavorable and that “the consequences of underutilization of statins may contribute to disparities in cardiovascular health outcomes.”

“For example, non-Hispanic Black adults experience 32% higher age-adjusted rates of cardiovascular mortality compared with non-Hispanic white persons,” they wrote.

Understanding racial, ethnic and gender differences in statin use could help improve ASCVD outcomes, according to Frank and colleagues. Therefore, the researchers conducted a cross-sectional analysis using 2015 to 2020 National Health and Nutrition Examination Survey data on persons recommended for statin care based on 2013 and 2018 American College of Cardiology/American Heart Association guidelines.

Of the 13,213 participants aged 21 to 75 years who were identified, 4,763 and 1,138 were eligible to receive a statin for primary or secondary prevention of ASCVD, respectively.

The overall prevalence of statin use was 37.6% (95% CI, 33.9-41.5) for primary prevention and 59.1% (95% CI, 54.8-63.2) for secondary prevention.

Frank and colleagues found that both non-Mexican Hispanic women (adjusted prevalence ratio [PR] = 0.74; 95% CI, 0.53-0.95) and non-Hispanic Black men (aPR = 0.73; 95% CI, 0.59-0.88) had a lower prevalence of statin use for primary ASCVD prevention compared with non-Hispanic white men.

Meanwhile, compared with non-Hispanic white men, lower prevalence of statins for secondary ASCVD prevention were seen in:

• non-Hispanic Black men (aPR = 0.81; 95% CI, 0.64-0.97);
• non-Hispanic white women (aPR = 0.69; 95% CI, 0.56-0.83);
• multiracial men or men of other ethnicities (aPR = 0.58; 95% CI, 0.2-0.97);
• non-Mexican Hispanic women (aPR = 0.57; 95% CI, 0.33-0.82);
• non-Hispanic Black women (aPR = 0.75; 95% CI, 0.57-0.92); and
• Mexican American women (aPR = 0.36; 95% CI, 0.1-0.61).

Because the prevalence rates were not explained by measurable disease factors, such as disease severity, or health care or socioeconomic resources, “they may partially reflect the role of unobserved factors that influence health inequities, including bias, stereotyping, and mistrust,” Frank and colleagues wrote.

The researchers noted several limitations to the study. For example, they could not determine whether statin disparities decreased over time or whether a person who did not receive statins had been previously prescribed statin treatment.

Frank and colleagues concluded that with statin disparities possibly contributing to disparities in cardiovascular morbidity and mortality, the findings highlight the need for societal interventions.

“These include clinical quality improvement initiatives to systematize statin prescriptions

among eligible patients, bias reduction training for prescribers, diversification of the health care provider workforce, and programs to regain trust among systematically marginalized groups that have experienced intergenerational scientific and clinical misconduct,” they wrote.