Differences In Statin Use Research Articles

Sex-based utilization of guideline recommended statin therapy and cardiovascular disease outcomes: Data from a multisite healthcare network primary prevention cohort

BackgroundIn the US, women have similar cardiovascular death rates as men. However, less is known about sex differences in statin use for primary prevention and associated atherosclerotic cardiovascular disease (ASCVD) outcomes. MethodsStatin prescriptions using electronic health records were examined in patients without ASCVD (myocardial infarction (MI), revascularization or ischemic stroke) between 2013 and 2019. Guideline-directed statin intensity (GDSI) at index (at least moderate intensity, defined per pooled-cohort equation) and follow-up visits were compared between sexes across ASCVD risk groups, defined by the pooled-cohort equation. Cox regression hazard ratios were calculated for statin use and outcomes (myocardial infarction, stroke/transient ischemic attack (TIA), and all-cause mortality) stratified by sex. Interaction terms (statin and sex) were applied. ResultsAmong 282,298 patients, (mean age ∼ 50 years) 17.1 % women and 19.5 % men were prescribed any statin at index visit. Time to GDSI was similar between sexes, but the proportion of high-risk women on GDSI at follow-up were lower compared to high-risk men (2-years: 27.7 vs 32.0 %, and 5-years: 47.2 vs 55.2 %, p < 0.05). When compared to GDSI, no statin use was associated with higher risk of MI and ischemic stroke/TIA among both sexes. High-risk women on GDSI had a lower risk of mortality (HR=1.39 [1.22–1.59]) vs. men (HR=1.67 [1.50–1.86]) of similar risk (p value interaction=0.004). ConclusionIn a large contemporary healthcare system, there was underutilization of statins across both sexes in primary prevention. High-risk women were less likely to remain on GDSI compared to high-risk men. GDSI significantly improved the survival in both sexes regardless of ASCVD risk group. Future strategies to ensure continued use of GDSI, specifically among women, should be explored.

Recommended and observed statin use among US adults with and without cancer.

Patients with cancer are at increased cardiovascular (CV) risk. We aimed to compare the recommended and observed statin use among individuals with and without cancer. Using three 2-year cycles from the National Health and Nutrition Examination Survey (2013-18), we analysed data from 17 050 US adults. We compared the prevalence of Class 1 statin recommendations and use between individuals with and without cancer, overall, and among different demographic groups. Individuals with a history of cancer were older and had a higher burden of comorbidities. Stratified by age groups, they were more likely to have a secondary prevention indication compared with individuals without cancer but not a primary prevention indication for statin. Among individuals with an indication for statin therapy, the prevalence of statin use was higher in the cancer group compared with those without cancer (60.8% vs. 47.8%, P < 0.001), regardless of sex, type of indication (primary vs. secondary prevention), and education level. However, the higher prevalence of statin use in the cancer group was noted among younger individuals, ethnic minorities, and those with lower family income. Our finding highlights the importance of optimization of CV health in patients with cancer, as individuals with cancer were more likely to have a Class 1 indication for statin treatment when compared with individuals without cancer. Important differences in statin use among cohorts based on sex, age, ethnicity, and socioeconomic status were identified, which may provide a framework through which CV risk factor control can be targeted in this population. Higher statin use in cancer patients: Among those with Class 1 recommendation to take statins, 60.8% of cancer patients were using them, compared with 47.8% of non-cancer individuals, indicating a greater adherence to heart health recommendations in the cancer group. Demographic variations in statin use: The study found notable differences in statin use among younger individuals, ethnic minorities, and those with lower income within the cancer patient group, suggesting disparities in how these subgroups manage their cardiovascular health.

Abstract P357: Gender Disparities in Utilization of Statins in Patients With Cancer and Atherosclerotic Cardiovascular Disease: Results From Houston Methodist Learning Health System Outpatient Registry

Background: Gender disparities in utilization of statins have been reported across patients with cardiovascular disease, however these patterns remain unknown amongst cancer patients. We sought to evaluate gender differences in statin use amongst cancer patients with atherosclerotic cardiovascular disease (ASCVD) using data from a large US healthcare system. Methods: Houston Methodist Learning Health System Outpatient Registry was utilized to obtain data of adult population between 2016 to 2022. All patients with a cancer and ASCVD diagnosis listed on their problems list using the ICD-10 CM codes were included. Statin use and dose were identified in the database using ATC codes, and this information was recorded based on medication reconciliation reviews with patients at each clinical encounter. Multivariate logistic regression analysis and chi-square test were utilized to compare statin use between the two genders. Results: A total of 16,926 patients with cancer and ASCVD were included (41.6% women). Women with cancer and ASCVD reported lower statin use (63.9% vs 73.7%; p&lt;0.01) and lower high-intensity statin use (27.5% vs 37.2%; p&lt;0.01) compared with men. Women with cancer and ASCVD were also less likely to have LDL-C&lt;70mg/dL (25.8% vs 35.2%; p&lt;0.01) compared with men. Consistent results were observed even after adjusting for demographic and cardiovascular risk factors (any statin OR 0.68 [0.63, 0.72]; high-intensity statin OR 0.66 [0.61, 0.70]). These disparities persisted across age (&lt;65, ≥65 years) and racial/ethnic (NHW, Hispanics, NHB, Asian/Other) strata. Conclusion: Although statins can potentially ameliorate risk of adverse cardiovascular events in patients with cancer, significant gender disparities exist in utilization of statins among US patients with cancer and established ASCVD, with women less likely to have guideline defined goal of LDL&lt;70 mg/dL and receive any and high-intensity statin therapy across age and racial/ethnic subgroups.

Ethnicity based differences in statin use and hypercholesterolemia control among patients with premature coronary artery disease-results of I-PAD study

BackgroundStatins use is the most important treatment for high LDL cholesterol in patients with premature coronary artery disease (CAD). Previous reports have shown racial and gender differences in statin use in the general population, but this wasn't studied in premature CAD based on different ethnicities. Methods and resultsOur study includes 1917 men and women with confirmed diagnosis of premature CAD. Logistic regression model was used to evaluate the high LDL cholesterol control in the groups and the OR with 95% confidence interval (CI) was reported as the effect size. After adjustment for confounders, the odds of controlling LDL in women taking Lovastatin, Rosuvastatin, and Simvastatin were 0.27 (0.03, 0.45) lower in comparison with men. Also, in participant who took 3 types of statins, the odds of controlling LDL were significantly different between Lor and Arab compared with Fars ethnicity. After adjustment to all confounders (full model), the odds of controlling LDL were lower for Gilak in Lovastatin, Rosuvastatin, and Simvastatin by 0.64 (0.47, 0.75); 0.61 (0.43, 0.73); 0.63 (0.46, 0.74) respectively and higher for Arab in Lovastatin, Rosuvastatin, and Simvastatin by 4.63 (18.28, 0.73); 4.67 (17.47, 0.74); 4.55 (17.03, 0.71) respectively compared to Fars. ConclusionsMajor differences in different gender and ethnicities may have had led to disparities in statin use and LDL control. Awareness of the statins impact on high LDL cholesterol based on different ethnicities can help health decision-makers to close the observed gaps in statin use and control LDL to prevent CAD problems.

Abstract 12870: Absence of LDL Measurement in Secondary Prevention is Associated With Increased Subsequent Major Adverse Clinical Event (MACE) That is Only Partially Mitigated by Statin Use

Introduction: There has been considerable discussion regarding the value of follow-up LDL-C measurements in secondary prevention of major adverse cardiac events (MACE). We therefore set out to determine in a large healthcare system whether measurement of LDL-C after an ASCVD event was associated with a difference in MACE during follow-up and whether differences in outcomes could be attributed to differences in statin use. Methods: The Intermountain Enterprise Data Warehouse was searched to identify all adults with a first encounter for ASCVD-including coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral arterial disease (PAD)—between January 1, 1995 and December 31, 2016 who survived the index event and were followed for ≥3 years or until death. Results: Patients (N=68,411) had an average age of 66±14 years; 65% were men; 70.3%, 21.0%, and 8.6% entered with CAD, CVD, and PAD, respectively. A statin was prescribed to 52% of patients during follow-up. A total of 33,698 (49%) did not have and 34,713 (51%) did have a follow-up LDL-C test prior to a subsequent MACE (death, MI, CVA, and revascularization) or end of follow-up. By 3 years, MACE occurred in 14,835 (37.4%) vs. 5,770 (20.1%) of those without vs. with an LDL-C measurement, respectively (Figure top). The multivariable hazard ratio for 3 year MACE based on measuring LDL-C was 0.47. The increased MACE rate associated with not measuring LDL-C was partially mitigated by statin use (Figure bottom). Only 44.7% vs. 58.9% of patients without vs. with LDL-C measurement were taking statins. Conclusion: These data indicate that there is a significant and clinically meaningful difference in MACE based on a follow-up measurement of LDL-C. Statin administration partially, but not completely mitigated the increased MACE rate. While these results are limited in that they are from a retrospective registry, they indicate that LDL-C should be measured, and statin should be administered after an initial ASCVD event.

Revising the atherosclerotic cardiovascular disease calculator without race

Revising the atherosclerotic cardiovascular disease calculator without race

Gender differences low-density lipoprotein cholesterol reduction with PCSK9 inhibitors in real world patients

Abstract Background Monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 55%, regardless of baseline treatments, and are supposed to have a homogenous effect. We tested possible gender differences in a large multicenter registry of real-world patients treated with PCSK9 inhibitors. Methods Multicentre and retrospective registry of patients treated with PCSK9 inhibitors from 14 different hospitals from Spain. Before and on-treatment LDLc cholesterol was recorded as well as medical treatments, clinical indication and clinical features. Results A total of 562 patients were analysed, mean age 60.2 (9.6) years and 79.2% males. Most frequent indication for PCSK9 inhibitor treatment was established cardiovascular disease (CVD) with LDLc &amp;gt;100 mg/dl (58.1%) followed by familial hypercholesterolemia (23.4%) and statin intolerance (18.5%). Indications other than CVD were more frequent in women (53.3% vs. 39.1%; p=0.03). Women were more frequently ezetimibe (67.5% vs. 50.6%; p=0.001) before PCSK9 treatment; although no gender differences in statin use was observed (78.6% vs. 83.6%; p=0.93) in the whole cohort it was significantly lower in patients with coronary heart disease (91.4% vs. 98.9%; p=0.005). Before treatment LDLc was 148.7 (50.1) mg/dl and it was higher women vs. men (160.3 (59.3) vs. 145.6 (47.0); p=0.005). Evolocumab was initiated in 318 (56.6%) patients; 229 (40.7%) alirocumab 75 mg and 15 (2.7%) alirocumab 150 mg. No gender differences in PCSK9 inhibitors drug or dose were observed. Median time to second blood determination were 187.5 (IQR 101–242) days. Mean on-treatment LDLc was 66.7 (46.4) mg/dl and it was also higher in women vs. men (84.4 (58.6) vs. 61.9 (41.3); p&amp;lt;0.001). Mean LDLc reduction was 54.7% but it was higher in men as compared to women (57.0% vs. 46.1%; p=0.0003). Higher LDLc reductions were also observed in patients with CVD as compared to the other 2 indications (57.1% vs. 47.3%; p=0.002). Moreover, LDLc reduction with PCSK9 inhibitors treatment was also higher in men vs women among patients with CVD (58.9% vs. 48.0%; p=0.04) Conclusions This multicentre and retrospective registry of real-world patients treated with PCSK9 inhibitors highlights significant gender differences in LDLc reduction. Funding Acknowledgement Type of funding sources: None.

Bicuspid aortic valve is associated with less coronary artery calcium and coronary artery disease burden by computed tomography

Abstract Background Bicuspid aortic valve (BAV) is associated with genetic defects (NOTCH 1, GATA 5 mutations) and aortopathy. Differences in flow pattern and a genetic predisposition could also affect coronary arteries. Purpose To assess the coronary artery calcium score (CACS) and coronary artery disease (CAD) burden by coronary computed tomography angiography (CTA) in patients with BAV stenosis, as compared to those with tricuspid aortic valve (TAV) stenosis. Methods 47 patients with congenital BAV (68.9 years±12.9, 38.3% females) who underwent cardiovascular CTA for TAVR planning were matched with 47 TAV patients for age, gender, smoking, arterial hypertension, dyslipidemia, diabetes, body-mass-index and chronic kidney disease. The coronary artery calcium score (CACS) (Agatston Units=AU) and coronary stenosis severity by CTA (CADRAD:&amp;lt;25% minimal,&amp;lt;50%milde,50–70%moderate,&amp;gt;70/%severe) were quantified. Results The coronary artery calcium score (CACS) was lower in BAV (237.4 vs. 1013.3AU; p&amp;lt;0.001), and coronary stenosis severity was less (CAD-RAD:p&amp;lt;0.001) as compared to patients with TAV. More patients with BAV had CACS zero (27.7% vs. 0%, p&amp;lt;0.001). The majority (68.1%) of patients with BAV had no or non-obstructive CAD but only 25.5% of tricuspid (p&amp;lt;0.001). Obstructive CAD (&amp;gt;50% stenosis) by CTA was more frequently observed in TAV patients (68.1%; p&amp;lt;0.001). There were no differences in statin use and NOAC, and other co-morbidities such as AF and COPD. Conclusion Patients with BAV have markedly less coronary artery calcium load and yielded less severe coronary stenosis. CTA succeeds to rule out obstructive CAD in the majority of patients with BAV, with adherent implications for TAVR planning. Funding Acknowledgement Type of funding sources: None. 72 YOM with BAV, zero CACS and no CADCACS was lower in BAV

Statin Use in Older Adults for Primary Cardiovascular Disease Prevention Across a Spectrum of Cardiovascular Risk.

There remains uncertainty regarding optimal primary atherosclerotic cardiovascular disease (ASCVD) prevention practices for older adults. To assess statin treatment patterns and incident ASCVD among older patients for primary prevention across the spectrum of ASCVD risk. Retrospective cohort study of participants without ASCVD aged 65-79 years. Patients were stratified by age (65-69, 70-75, > 75 years) and 10-year ASCVD risk category (low/borderline, intermediate, high) based on the Pooled Cohort Equations. Multivariable logistic regressions were used to identify predictors of moderate- or high-intensity statin prescriptions. Cox proportional models were used to estimate hazard ratios (HRs) for incident ASCVD. Patients aged 65-79 years without ASCVD from a Northern California health system. Statin prescriptions and incident ASCVD events. There were 54,066 patients, with 10,288 (19%) aged > 75 years and 57% women. Compared with younger groups, adults > 75 years were less likely to be prescribed moderate- or high-intensity statin prescriptions across ASCVD risk groups (all p < 0.001); this persisted after multivariable adjustment including for ASCVD risk (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74-0.86). Adults > 75 years were more likely to experience incident ASCVD (HR 1.42, 95% CI 1.23-1.63). Women (OR 0.85, 95% CI 0.81-0.89) and underweight older adults (OR 0.45, 95% CI 0.33-0.61) were also less likely to receive moderate- or high-intensity statins. Among older adults aged 65-79 years without prior ASCVD, those > 75 years of age were less likely to receive moderate- or high-intensity statins regardless of ASCVD risk compared with their younger counterparts, while experiencing more incident ASCVD. Efforts are warranted to study the reasons for age-based differences in statin use in older adults, particularly those at highest ASCVD risk.

Uptake of Statin Guidelines to Prevent and Treat Cardiovascular Disease.

In December 2013, cholesterol treatment guidelines changed the approach to statin therapy by recommending fixed doses of low-, medium-, or high-intensity statins based on cardiovascular risk. We sought to evaluate the guideline's adoption in a diverse group of practices. Using a mixed-methods approach, we analyzed electronic health record data the year before and 2 years following guideline publication in 45 practices across 8 states. We examined associations based on patient, clinician, and practice characteristics and interviewed 24 clinicians and practice leaders to inform findings. The proportion of patients adherent with all recommendations 2 years after the guideline only increased from 18.5% to 20.3% (P < .01). There were clinically insignificant increases in statin use across risk strata (1.7% to 3.5%) and small increases in high-intensity statin use (2.6% to 4.6%). Only half of patients with cardiovascular disease (52.9%) were on any statin, not much different from patients at moderate (49.6% to 50.9%) or low (41.6% to 48.7%) risk. Multiple patient (risk, use of health care), clinician (age), and practice (type, rurality) factors were associated with statin use. Clinicians reported patient resistance to statins but liked having a risk calculator to guide discussions. Despite general agreement with statin benefit, the guideline was poorly implemented. Marginal differences in statin use between the highest and lower risk strata of patients is concerning. Rather than intensifying statin potency and recommending more patients take statins, guidelines may want to focus on ensuring that those who will benefit most get treatment.

Abstract 04: Gender and Racial Inequalities in the Use of Statins for Secondary Prevention of Cardiovascular Disease Remains Despite Persistent Recommendations in Recent Guidelines - A Call to Action

Introduction: Statins use for secondary cardiovascular disease (CVD) prevention is associated with better health outcomes and lower cost among adults with ASCVD. We aimed to examine the prevalence of statin use among adults with ASCVD in the US and to assess for gender and racial differences in statin use. Methods: We identified adults aged 40-75 years with ASCVD (defined using ICD codes and self-reported history) from the 2008-17 Medical Expenditure Panel Survey (MEPS) data. We estimated the trends in statin use among them, and used joint point regression (JPR) to estimate the annual percentage change in statin use. Logistic regression was used to assess the racial variation in statin use. We applied the weights in the MEPS complex survey design to estimate population sizes, so all results are nationally representative. Results: Between 2008 and 2017, 24896 adults aged 40-75 years with ASCVD were identified. In 2017, there were 2445 patients with ASCVD (equivalent to 24.5 million adults). In 2017, the mean age [SE] was 62.2 [0.3] years, and 42.9% were females. The overall proportion of adults with ASCVD using statin increased from 50.0% in 2008 to 58.7% in 2017, with an average annual percentage change of 0.95% between 2010 and 2017 ( p= 0.01). As shown in Figure 1a , among those with ASCVD, statin use was persistently lower in women than in men. In 2017, compared to White adults with ASCVD, Blacks (OR=0.69; 95% CI: 0.51-0.92) and Hispanics (OR=0.62; 95% CI: 0.45-0.85) were less likely to be on statin. Each year, over 3 million women with ASCVD were not on statin, and majority of them were Blacks and Hispanics. (Figure 1b) Conclusion: Millions of adults with ASCVD are not on statins in the US while gender and racial inequalities in statin use remains, despite persistent guideline recommendations. Herein lies an opportunity to improve CVD-related outcomes and cost by intensifying efforts to use statins for the secondary prevention of CVD and closing gender and racial gaps, especially with the 2030 sustainable development goals in view.

Association of Patient Perceptions of Cardiovascular Risk and Beliefs on Statin Drugs With Racial Differences in Statin Use

African American individuals face higher atherosclerotic cardiovascular disease risk than white individuals; reasons for these differences, including potential differences in patient beliefs regarding preventive care, remain unknown. To evaluate differences in statin use between white and African American patients and identify the potential causes for any observed differences. Using the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data, we compared statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins. A total of 138 US community health care practices contributed to the data. Data analysis was conducted from March 2017 to May 2018. Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs. Poisson regression was used to evaluate the association between race and statin undertreatment, a category combining people who were not taking a statin or those taking a dose intensity lower than recommended. A total of 5689 patients (806 [14.2%] African American) in the PALM registry were eligible for statin therapy. African American individuals were less likely than white individuals to be treated with a statin (570/807 [70.6%] vs 3654/4883 [74.8%]; P = .02). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 [33.3%] vs 2145 [43.9%], respectively; P < .001; relative risk, 1.07 [95% CI, 1.00-1.15]; P = .05, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 [76.0-121.0] mg/dL vs 85.0 [68.0-105.0] mg/dL; P < .001). African American individuals were less likely than white individuals to believe statins were safe (292 [36.2%] vs 2800 [57.3%]; P < .001) or effective (564 [70.0%] vs 3635 [74.4%]; P = .008) and were less likely to trust their clinician (663 [82.3%] vs 4579 [93.8%]; P < .001). Group differences in statin undertreatment were not significant after adjusting for demographic, clinical, and clinician factors, socioeconomic status, and patient beliefs (final adjusted relative risk, 1.03 [95% CI 0.96-1.11]; P = .35). African American individuals were less likely to receive guideline-recommended statin therapy. Demographic, clinical, socioeconomic, belief-related, and clinician differences contributed to observed differences and represent potential targets for intervention.

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Statins reduce the risk of cardiovascular disease in patients with diabetes. This study examined the prevalence of statin use and assessed long-term adherence and persistence among people aged ≥65 years with diabetes. Pharmaceutical Benefits Scheme data covering a 10% random sample of the Australian population were analyzed. Among older adults with diabetes, the yearly prevalence of statin use was compared via Poisson regression modeling using 2006 as the reference year. A cohort of 7400 new statin users (mean age 72.9 years; 46.2% female) was followed longitudinally. Adherence was assessed via the proportion of days covered (PDC). Statin discontinuation was defined as the first ≥90 days without statin coverage. The prevalence of statin use increased from 52.0% in 2006 to 71.2% in 2016 (age and sex-adjusted rate ratio 1.37; 95% confidence interval 1.33-1.41). No gender differences in statin use were observed, but the likelihood of being dispensed statin decreased with increasing age. Among the longitudinal cohort, the proportion adherent (PDC ≥0.80) decreased from 54.0% at 6 months to 37.0% at 9 years. Over a mean follow-up of 4.9 years, 66.8% discontinued, and the likelihood of stopping statin medication within the first year was 42.7%. No age or gender differences in statin discontinuation were evident. Statin use has increased among older adults with diabetes. However, adherence is low and discontinuation is high. Further investigations into the factors associated with non-adherence or discontinuation of statins are important so as to optimize statin use towards achieving the intended cardiovascular benefits among older people with diabetes.

Trends and disparities in statin use and low-density lipoprotein cholesterol levels among US patients with diabetes, 1999–2014

AimsThe 2013 American College of Cardiology/American Heart Association Guideline defined patients with diabetes aged 40–75 years as a major statin benefit group. We explored the temporal trends and disparities in statin utilization and LDL-C levels among patients with diabetes aged 40–75 years. MethodsA total of 4860 patients from the National Health and Nutrition Examination Survey 1999 to 2014 were included in this study. Differences in statin use and LDL-C levels were explored by patient characteristics. ResultsFrom 1999–2002 to 2011–2014, the prevalence of statin use increased from 26.2% to 49.5% (Ptrend < 0.001). This was accompanied by a continuous decrease in the mean LDL-C level (from 115.8 mg/dL to 103.3 mg/dL, Ptrend < 0.001). The use of guideline-defined high-potency statin medications (atorvastatin and rosuvastatin) remained largely unchanged (from 14.0% to 17.9%, Ptrend = 0.55). Statin utilization increased with age. Women and blacks were 10% and 16% less likely to receive statin treatment compared with men and whites, respectively. In comparison with other statin treatment, use of atorvastatin or rosuvastatin was associated with average LDL-C reduction of 8.0 mg/dL. LDL-C levels were significantly higher among women and black patients. After adjustment for potential confounders, age and Hispanic-white differences in statin use and LDL-C levels were substantially attenuated. ConclusionsDespite a steady increase in statin use during the 16-year study period, statin therapy remains underutilized in certain subgroups of patients. Confounding factors related to healthcare utilization account for some of the disparities in statin use and LDL-C levels.

Statin and Aspirin Use Among Hispanic and Latino Adults at High Cardiovascular Risk: Findings From the Hispanic Community Health Study/Study of Latinos.

BackgroundDespite variations in the prevalence of cardiovascular disease and related risk factors among US Hispanic/Latino adults of diverse backgrounds, there is little information on whether disparities exist in the use of medications for the primary and secondary prevention of cardiovascular disease. We examined the prevalence of statin and aspirin use among diverse US Hispanic/Latino adults at high cardiovascular risk.Methods and ResultsA multicenter population‐based study, the Hispanic Community Health Study/Study Of Latinos, included a total of 16 415 participants of Mexican, Puerto Rican, Cuban, Dominican, South American, and Central American backgrounds who were aged 18 to 74 years and enrolled between March 2008 and June 2011. Our analyses were limited to 4139 participants considered to be at high cardiovascular risk. Age‐adjusted prevalence of statin and aspirin use was 25% and 44%, respectively, overall but varied by Hispanic/Latino background among those at high cardiovascular risk; statin use was significantly higher (P<0.001) among adults of Puerto Rican (33%) and Dominican (28%) backgrounds compared with adults of other backgrounds (Mexican, 24%; Cuban, 22%; Central American, 20%; South American, 22%). There was no difference in aspirin use. After adjusting for health insurance coverage, the difference in prevalence of statin use was substantially reduced among participants with a Puerto Rican background, from an odds ratio of 1.73 (95% CI 1.30–2.31) to 1.30 (95% CI 0.97–1.75), and with a Dominican background, from an odds ratio of 1.45 (95% CI 1.04–2.02) to 1.07 (95% CI 0.75–1.52), in comparison to their counterparts.ConclusionsAmong Hispanic/Latino adults of diverse backgrounds, statin use was more prevalent among adults with Puerto Rican and Dominican backgrounds at high cardiovascular risk. These differences in statin use were explained, in part, by differences in insurance coverage. These findings have important implications for the prevention of disparities in cardiovascular outcomes within the growing US Hispanic/Latino population.

Abstract 17360: Four Factors Explain Most of the Gender Disparity in Statin Therapy

Despite well documented gender disparities in statin therapy, the reasons underlying these differences remain obscure. Applying natural language processing to a retrospective cohort of 24,338 patients with coronary artery disease (CAD) treated in primary care practices (PCP) affiliated with two academic medical centers between 01/01/2000 and 12/31/2011, we studied contribution of smoking, age, cardiologist evaluation and adverse statin reactions to gender differences in statin use. Two thirds of the patients were men (Table); 85.6% received statins during the study period and 69.7% had persistent statin therapy (active statin prescription at the last PCP visit). Women were less likely than men to have been treated with a statin but equally likely to have persistent statin therapy after statin initiation. Women were older, less likely to have ever smoked, less likely to have been seen by a cardiologist and more likely to have reported an adverse reaction to a statin. In multivariable analysis of all subjects, patients with history of smoking (OR 1.304), younger age (OR 1.016), or cardiologist evaluation (OR 1.797) were more likely (p &lt; 0.001 for all) to have persistent statin therapy. Direct estimations of the effect of the differences in joint distributions of the covariates between men and women showed the following contributions to gender differences in persistent statin therapy: age 51.7%, smoking 31.5%, cardiologist evaluation 24.2%, and adverse statin reactions 6.7%. Together, these four factors contributed 89.9% to the gender disparity in persistent statin therapy. In 24,000 patients in whom statin therapy was clearly indicated, several specific factors appear to underlie differences in statin therapy and it’s persistent use between men and women. Identifying such drivers may facilitate interventions and further research to overcome gender differences in applying proven interventions for cardiovascular risk reduction.

Age-related macular degeneration and cognitive impairment show similarities in changes of neutral lipids in peripheral blood mononuclear cells

Starting from previous studies showing that patients with cognitive deficit present neutral lipids (NLs) accumulation in cytoplasm of their peripheral blood mononuclear cells (PBMCs) and considering that there is epidemiological evidence linking age-related macular degeneration (AMD) to cognitive deficit, the first purpose of this study was to test whether neutral lipids also accumulated in PBMCs from AMD subjects. Moreover, the impact of statin use on AMD was explored and whether such use in AMD subjects was associated with NLs accumulation in PBMCs. The study was conducted on 222 subjects: 136 AMD (36 of which – 26.5% – using statins], 48 cognitive deficit (20 of which – 41.7% – using statins) and 38 healthy controls (4 of which −10.1% – using statins), AMD lesions were assessed from color fundus photographs. Mini-mental state examination (MMSE), demographics, lifestyle factors and medical history were collected at interview. MMSE score was categorized as normal (24–30), and impaired (<24), NLs content was evaluated by oil red 0 (ORO) staining method. ORO determination showed that neutral lipids were generally absent or very low (score between 0 and 1) in healthy controls while most of PBMCs from cognitive deficit and AMD had ORO staining levels scoring 2–4. Post hoc analysis (Bonferroni) in a one-way ANOVA revealed that ORO score was significantly higher in cognitive deficit and AMD subjects compared to healthy controls and in cognitive deficit compared to AMD. Bonferroni-test also showed that AMD subjects had significantly lower total cholesterol (TC) levels compared to healthy controls while high density lipoprotein-cholesterol (HDL-C) did not reach statistical significance. The results also revealed a significant higher number of statin-users in AMD compared to healthy controls. Likewise when cognitive deficit vs healthy controls was analyzed, the number of statin users were found to be significant higher in cognitive deficit than in healthy controls. There were no significant differences in statin use between AMD and cognitive deficit. Compared to healthy controls, statin use in cognitive deficit and AMD groups was significantly associated with ORO scores of 2–4. This data supports the hypothesis that AMD and cognitive deficit share similar complex pathophysiology and risk factors including NLs accumulation in their PBMCs, although this does not necessarily imply that one disease causes the other. In addition, they provide further evidence that statin use may increase the risk of AMD.

Incidence and Predictors of Hospitalization for Bacterial Infection in Community-Based Patients with Type 2 Diabetes: The Fremantle Diabetes Study

BackgroundThe few studies that have examined the relationship between diabetes and bacterial infections have utilized administrative databases and/or have had limited/incomplete data including recognized infection risk factors. The aim of this study was to determine the incidence and associates of bacterial infection severe enough to require hospitalization in well-characterized community-based patients with type 2 diabetes.Methods and FindingsWe studied a cohort of 1,294 patients (mean±SD age 64.1±11.3 years) from the longitudinal observational Fremantle Diabetes Study Phase I (FDS1) and 5,156 age-, gender- and zip-code-matched non-diabetic controls. The main outcome measure was incident hospitalization for bacterial infection as principal diagnosis between 1993 and 2010. We also examined differences in statin use in 52 FDS1 pairs hospitalized with pneumonia (cases) or a contemporaneous non-infection-related cause (controls). During 12.0±5.4 years of follow-up, 251 (19.4%) patients were hospitalized on 368 occasions for infection (23.7/1,000 patient-years). This was more than double the rate in matched controls (incident rate ratio (IRR) (95% CI), 2.13 (1.88–2.42), P<0.001). IRRs for pneumonia, cellulitis, and septicemia/bacteremia were 1.86 (1.55–2.21), 2.45 (1.92–3.12), and 2.08 (1.41–3.04), respectively (P<0.001). Among the diabetic patients, older age, male sex, prior recent infection-related hospitalization, obesity, albuminuria, retinopathy and Aboriginal ethnicity were baseline variables independently associated with risk of first hospitalization with any infection (P≤0.005). After adjustment for these variables, baseline statin treatment was not significant (hazard ratio (95% CI), 0.70 (0.39–1.25), P = 0.22). Statin use at hospitalization for pneumonia among the case-control pairs was similar (23.1% vs. 13.5%, P = 0.27).ConclusionsThe risk of severe infection is increased among type 2 diabetic patients and is not reduced by statin therapy. There are a number of other easily-accessible sociodemographic and clinical variables that could be used to optimize infection-related education, prevention and management in type 2 diabetes.

Understanding Gender Differences in Statin Use among Elderly Medicare Beneficiaries

Pharmacotherapy with statins (HMG-CoA reductase inhibitors) is the cornerstone for lipid management in individuals with or at risk of developing cardiovascular diseases. Although the clinical benefits of statins are established for both women and men, there is evidence of a gender difference in their use. The current study extends prior scientific research by estimating the extent to which individual-level variables may explain gender differences in statin use by using a post-regression non-linear decomposition technique. The objective of this study was to estimate the magnitude of gender differences in statin use among the elderly and examine individual-level variables that can explain the gender differences in statin use among elderly individuals with or at risk of cardiovascular diseases. A retrospective cross-sectional study design was adopted. Data were derived from the 2005 Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of Medicare beneficiaries in the US. The analytic study sample consisted of community-dwelling elderly Medicare beneficiaries, aged 65 years or older, who had reported any of the following conditions: heart disease, hyperlipidaemia or diabetes mellitus, and who were alive during the observation year. Chi-square tests were used to evaluate the unadjusted associations between gender and statin use for each of the characteristics. Multivariate logistic regressions were used to evaluate the relationship between gender and statin use. A post-regression non-linear decomposition approach was used to understand individual-level variables that could explain gender differences in statin use. Among 5,508 elderly, 47.2% of the women and 55.5% of the men reported any statin use in 2005, which translates to an 8.3 percentage point difference in statin use. In the multivariate logistic regression on statin use, women were 21% less likely than men to use statins (adjusted odds ratio = 0.79; 95% CI 0.69, 0.89). Post-regression non-linear decomposition analysis revealed that of the 8.3 percentage point difference in statin use, 29.5% was explained by the individual-level variables. Lifestyle risk factors accounted for most of the explained portion of the gender difference in statin use. Among elderly Medicare beneficiaries, women were less likely than men to report any use of statins. Less than one third of the total gender difference in statin use was attributed to individual-level variables such as demographics, economic status, physical health status, depression and lifestyle risk factors. Further research is needed to identify whether provider and/or organizational-level factors can further explain the gender difference in statin use.

Socioeconomic differences in statin use after deregulation of simvastatin in the UK: the Whitehall II prospective cohort study

To examine socioeconomic differences in statin use after deregulation of simvastatin in adults with moderate or high risk of coronary heart disease. Prospective cohort study. 20 civil service departments in...