A cross-sectional analysis of data from the National Health and Nutrition Examination Surveys (NHANES) indicated Black and Hispanic participants had significantly lower statin use than White participants for primary prevention of atherosclerotic cardiovascular disease (ASCVD).¹

According to the findings, the overall prevalence of statin use was low among race and ethnicity groups from 2013 to March 2020, particularly for individuals with an ASCVD risk of 20% or greater.

The investigative team, led by Joshua A. Jacobs, PharmD, Spencer Fox Eccles University of Utah School of Medicine, suggested the significant differences in prevalence of statin use observed in the study highlight the importance of identifying relevant factors to reduce inequities in cardiovascular health.

“These findings demonstrate the persistent racial and ethnic disparities in guideline-recommended statin use for primary prevention among at-risk adults and represent an opportunity to advance pharmacoequity in primary prevention,” Jacobs and colleagues wrote.

Prior data report a higher burden of ASCVD and lack of access to cardiology specialists among Black and Hispanic adults. Studies investigating statin use in primary prevention populations have been limited in scope or do not include temporal trends of current 10-year ASCVD risk categorization. To better quantify gaps in knowledge, the investigative team evaluated the prevalence of statin use for primary prevention of ASCVD by race and ethnicity according to pooled cohort equation (PCE)-predicted 10-year ASCVD risk strata among NHANES participants.

The analysis pooled participants from 3 cycles: 2013 to 2014, 2015 to 2016, and 2017 to March 2020, because of the COVID-19 pandemic. Ten-year predicted ASCVD risk was calculated using the PCE and divided into categories: 5% to <7.5%, 7.5% to <20%, and ≥20%. A total of 11,536 participants in NHANES aged 40 to 75 years who self-identified as Asian, Black, Hispanic, or White were assessed for inclusion.

The primary outcome was the prevalence of statin use, defined as the identification after interviewer pill bottle review. For the primary analysis, Poisson regression with adjustment for NHANES cycle was used to determine the association of race and ethnicity and ASCVD risk stratum with statin use. Among 3417 included participants, 1289 were women and 2128 were men, yielding an estimated 14.9 million (37.8%) female participants and 24.5 million (62.2%) male participants with a mean age of 61.8 years.

By self-report, 329 participants were Asian (weighted percentage, 4.2%), 1032 were Black (weighted percentage, 12.7%), 786 were Hispanic (weighted percentage, 10.1%), and 1270 were White (weighted percentage, 73.0%). Overall prevalence of statin use was 25.5% (95% CI, 23.3 – 27.9). The proportion of participants with a 10-year predicted ASCVD risk of 5% to <7.5% was 31.0%, 7.5% to <20% was 58.3%, and ≥20% was 10.7%

In analysis, statin use was significantly lower among Black and Hispanic participants and comparable among Asian participants when compared with White participants (Asian, 26.5%; Black, 20.0%; Hispanic, 15.4%; White, 27.9%), as well as across each ASCVD risk strata. Within each race and ethnicity group identified, a graded increase in the prevalence of statin use was reported across ASCVD risk strata, according to investigators.

Data showed the use of statins in the highest risk strata remained low overall and was significantly lower among Black participants (23.8; prevalence ratio [PR], 0.90; 95% confidence interval [CI], 0.82 – 0.98) and Hispanic participants (23.9%; PR, 0.90; 95% CI, 0.81 – 0.99). Adjusted analyses revealed higher ASCVD risk strata had significantly greater prevalence of statin use across each race and ethnicity group. Among measures of social determinants of health, access to routine health care and health insurance were found significantly associated with a greater prevalence statin use across all evaluated race and ethnicity groups.

“Together, these findings suggest that existing inequities in access to preventive care may be associated with the underuse of statins across race and ethnicity groups,” investigators wrote.

References

1. Jacobs JA, Addo DK, Zheutlin AR, et al. Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US: National Health and Nutrition Examination Surveys, 2013 to March 2020. JAMA Cardiol. Published online March 22, 2023. doi:10.1001/jamacardio.2023.0228