This transcript has been edited for clarity.
This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I'd like to talk with you about a recent report in Annals of Internal Medicine that assessed the prevalence of statin use according to sex, race, and ethnicity.
The authors looked separately at statin use in primary and secondary prevention settings, and they made use of the enhanced national survey data in to have a representative sampling of Americans. They applied the ACC/AHA guidelines for starting statins to look at appropriate use of statins for both primary and secondary prevention of cardiovascular disease.
Special strengths of the study were that they addressed several patient-specific factors as well as socioeconomic and health insurance–related factors. They accounted for age, but also severity of underlying disease and comorbidity status, and then looked at the individual's educational level; household income; and whether they had health insurance, prescription coverage, and general access to care.
The findings showed some substantial disparities that were not fully explained by these patient-specific and even socioeconomic and health insurance–related factors. I'm going to start with secondary prevention, because the indications for statin use are so clear in that setting.
Compared with non-Hispanic White men, whom the researchers used as the referent, there were disparities of lower prevalence of statin use among non-Hispanic Black men and also among multiracial men. Among women in secondary prevention, the disparities in statin use were even more stark. Compared with non-Hispanic White men, the prevalence of statin use was 40%-60% lower in Hispanic women, 30% lower in non-Hispanic White women, and 25% lower in non-Hispanic Black women. The only group of women who didn't have a lower prevalence of statin use was Asian women.
In primary prevention, disparities were seen compared with non-Hispanic White men. Non-Hispanic Black men in primary prevention had about 25% lower prevalence of statin use, and non-Mexican Hispanic women also had close to 25% lower use.
The authors concluded that these disparities were not fully explained by the patient-specific or even health insurance and socioeconomic factors. They propose that an explanation might be bias, stereotyping, and even distrust of the healthcare system among certain marginalized groups. This is a very complex issue, obviously, and the findings have implications beyond statin use. Similar disparities have been seen for other treatments, such as coronary cardiac catheterization, percutaneous coronary interventions, and even cardiac rehabilitation referrals and participation.
Different approaches to this problem could include making changes in healthcare system processes that would make the prescription of statins more systematic; for example, patients who have certain indications would prompt clinicians within the system. Also needed is improved communication between clinicians and patients, such as more discussion with the patient about why the medication is being prescribed and why statins are so important in preventing cardiovascular disease, and asking the patient whether they have concerns about the treatment. If the patient does develop certain symptoms such as muscle aches or other symptoms and wants to stop taking the statin, continue that conversation, try changes in dose or statin type or even change to another medication, and follow up on these issues at subsequent visits. Hopefully many of these changes that could be made in the healthcare system itself and in clinician-patient conversations and communication could help to reduce some of these disparities.
Thank you so much for your attention.
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Cite this: Statin Use Disparities: Time to Close the Gaps - Medscape - Sep 27, 2023.
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