A new study published in JAMA: Cardiology on June 13 suggests black patients have a higher risk of atherosclerotic cardiovascular disease (ASCVD) and are less likely to receive guideline-appropriate statin therapy than their white counterparts.
The researchers, led by Michael G. Nanna, MD, of Duke University Medical Center in Durham, North Carolina, sought to evaluate differences in statin use between white and black patients and identify potential causes for any observed differences.
They analyzed the health data of 5,689 patients from the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data to compare statin use and dosing between black and white outpatient adults who may have been eligible for primary of secondary prevention statins.
The researchers found black patients overall were only 4 percent less likely than white patients to be treated with a statin. However, among black patients who were treated, they were less likely to receive statins at guideline-recommended intensity, after adjusting for demographics, clinical characteristics, socioeconomic status and lower frequency of care by cardiologists accounted for the differences. The researchers noted this was consistent with previous studies.
Based on the 2013 American College of Cardiology/American Heart Association cholesterol guidelines that recommend moderate or high-intensity statin therapy, dependent on patient risk, only 33 percent of blacks received the appropriate statin intensity compared to 44 percent of whites.
“Lower use of appropriate intensity statins among African American patients compared with white patients contributed to higher LDL-C levels observed among African American patients. Given that the association between even a modest LDL-C reduction and cardiovascular disease risk reduction of major vascular events is well established, differences in appropriate statin therapy use and corresponding differences in LDL-C levels may partially explain differences in ASCVD burden between African American and white adults,” Nanna and colleagues wrote.
Blacks were also less likely to believe statins were safe and less likely to trust their physician.
“Future interventions must consider this complexity while being driven by identified patient perceptions, attitudes, and concerns,” Nanna et al. concluded. “While improving racial disparities may help reduce the burden of atherosclerotic cardiovascular disease in African American patients, most African American and white patients were not receiving guideline-appropriate statin therapy. Greater emphasis on following national guidelines when treating both African American patients and white patients may improve care and outcomes for all patients.”
The researchers noted some limitations to their study. They did not assess the reasoning behind clinician decisions whether or not to prescribe statin therapy. Patient refusal or contraindications to therapy in blacks and whites could also be a factor in patients not receiving statins.
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.