Abstract 13930: Sex and Race/Ethnic Differences in Primary Prevention of Atherosclerotic Cardiovascular Disease Among Patients Diagnosed With Hypertension

Abstract

Introduction: Randomized controlled trials evidence indicates that atherosclerotic cardiovascular disease (ASCVD) can be prevented in patients with hypertension if risk factors such as high blood pressure, high cholesterol, elevated glucose levels, and smoking are controlled. While it is known that sex and race/ethnic disparities persist for ASCVD, disparities in risk factor control have not been well-described in primary care. Methods: Hypertensive adult patients free of ASCVD were included in a retrospective analysis of electronic health record data from a large US integrated healthcare system from 2018. Patients were categorized based on achieving clinical practice guideline targets from their last available measurement including blood pressure <130/80 mm Hg; statin therapy among patients with indication (LDL-C >190, diabetic between ages 40-70, or with 10-year ASCVD score ≥7.5%), HbA1c of <7%, and not smoking. Multivariable Poisson regressions were developed to explore associations between achieving three targets (A1c reported separately among patients with value) and sex and race/ethnicity. Results are presented as relative risk (RR) and 95% confidence intervals (95%CI) and adjusted for age, obesity, years since hypertension diagnosis, and insurance, sex, insurance, preferred language. Results: Among women, African Americans were 11% more likely to fail to achieve the three targets (RR:1.11; 95%CI: 1.01-1.21). Among men, African Americans were 19% more likely to fail to achieve the three targets compared to Caucasian men (RR: 1.19; 95%CI: 1.05-1.35). The risk of failing to achieve the three targets was not statistically significantly different between Hispanic/Latino groups and Caucasians but trended to be smaller. Hispanic/Latino women (47.2%) and men (50.9%) had the highest proportions of failing to achieve HbA1c targets. Conclusions: Disparities were observed in control of ASCVD risk factors among hypertensive patients in primary care and were not fully explained by measured demographic or clinical characteristics. Monitoring of changes in disparities across sex, racial, and ethnic groups is important to ensure equity effectiveness as interventions to prevent ASCVD in primary care are developed, tested, and implemented.