Abstract 16329: Statin Prescription and ASCVD Outcomes in a Secondary Prevention Cohort Stratified by Race

Abstract

Introduction: Racial disparities in ASCVD outcomes and statin prescription have been previously described. However, disparities in utilization of statin therapy in real-world practice persist. We evaluated the association of statin prescription and incident ASCVD outcomes stratified by race in a large healthcare system. Methods: Statin prescription in Black and White patients with ASCVD was evaluated (2013-2022). Guideline Directed Statin Intensity (GDSI) was defined as high intensity and “<GDSI” as low or moderate intensity. Statin prescription (at index and follow-up) and ASCVD outcomes (CAD, stroke, mortality) were assessed via electronic health care records using ICD-9 and 10 codes. Cox regression models, adjusted for CVD risk factors, were used to calculate HRs for the association between statin prescription and incident ASCVD events, stratified by race. Results: Of a total 44,632 patients, 5.8% identified as Black and 94.2% as White with a similar proportion of statin therapy prescribed at baseline (47% vs. 48%, p > 0.05). Black patients without statin were initiated on <GDSI [2.3 vs. 1.5mo] and GDSI [3.8 vs. 2.3mo] later than White patients (all p<0.05) in a 5-year time frame. When comparing no statin use to <GDSI, there was a ~two-fold increase in IR of stroke (51.2 vs. 25.4 per 1000-person yrs) in Black patients versus White (23.4 vs. 16.9). GDSI was associated with lower risk of all ASCVD outcomes in patients of both races. Black patients had a greater relative benefit from GDSI for stroke than White patients. (HR stroke 0.38[0.27-0.53] vs 0.55[0.49-0.63]; p-interaction <0.01) (Table). Conclusions: In a large healthcare system, only ~half of Black and White patients with history of ASCVD received GDSI. Although it took longer to start Black patients on GDSI, GDSI was associated with less recurrent ASCVD outcomes in both races more than <GDSI or no statin use. The relative benefit of stroke prevention from GDSI was higher among Black patients.