Abstract
Lipid-lowering therapies are essential for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to identify discrepancies between cholesterol management guidelines and current practice with a focus on statin treatment in an underserved population based in a large single urban medical center. Among 1042 reviewed records, we identified 464 statin-eligible patients. Age was 61.0 ± 10.4 years and 53.9% were female. Most patients were black (47.2%), followed by Hispanic (45.7%) and white (5.0%). In total, 82.1% of patients were prescribed a statin. An appropriate statin was not prescribed in 32.4% of statin-eligible patients who qualified based only on a 10-year ASCVD risk of ≥7.5%. After adjustment for gender and health insurance status, appropriate statin treatment was independently associated with age >55 years (OR = 4.59 (95% CI 1.09–16.66), p = 0.026), hypertension (OR = 2.38 (95% CI 1.29–4.38), p = 0.005) and chronic kidney disease (OR = 3.95 (95% CI 1.42–14.30), p = 0.017). Factors independently associated with statin undertreatment were black race (OR = 0.42 (95% CI 0.23–0.77), p = 0.005) and statin-eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 (95% CI 0.07–0.25), p < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to black patients (86.8% vs. 77.2%). Statin underprescription is seen in approximately one out of five eligible patients and is independently associated with black race, younger age, fewer comorbidities and eligibility via 10-year ASCVD risk only. Hispanic patients are more likely to be on appropriate statin therapy compared to black patients.
Highlights
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality globally, with over 600,000 deaths in the United States annually [1,2]
The AHA/ACC cholesterol guidelines emphasize appropriate statin therapy and the monitoring its efficacy in statin-eligible groups to reduce the risk of micro- and macrovascular complications related of its efficacy in statin-eligible groups to reduce the risk of micro- and macrovascular complications to dyslipidemia
The AHA/ACC cholesterol guidelines emphasize proper screening and treatment monitoring to ensure that lipid-lowering agents are appropriately dosed and adjusted
Summary
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality globally, with over 600,000 deaths in the United States annually [1,2]. Statins are an effective therapy for the primary and secondary prevention of ASCVD, with proven mortality benefits and Healthcare 2020, 8, 361; doi:10.3390/healthcare8040361 www.mdpi.com/journal/healthcare. Younger black patients are vulnerable to these disparities in statin prescription patterns [6]. This effect of age and race on statin prescription, compounded by a general delay in the adoption of new guidelines by healthcare providers, leads to suboptimal patient care in these populations [7]. The objectives of this study were (1) to identify discrepancies between cholesterol management guidelines and current practice in an inner city academic center primary care population; and (2) to provide insights into possible interventions aimed at improving statin prescribing rates and reducing the incidence of ASCVD in this vulnerable cohort
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