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Statin Use for Primary Prevention of ASCVD by Race and Ethnicity
Quick Takes
- Higher ASCVD risk was associated with higher rates of statin use; however, statin use was low in general.
- Based on NHANES data, Black and Hispanic participants had significantly lower statin use than White adults in the US.
- Health insurance or a routine location for health care was significantly associated with increased statin use across race and ethnicity groups.
Study Questions:
Does the prevalence of primary prevention statin use vary by race and ethnicity?
Methods:
This was a serial, cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) collected between 2013 and 2020. Participants aged 40-75 years without atherosclerotic cardiovascular disease (ASCVD), diabetes, or low-density lipoprotein cholesterol levels of ≥190 mg/dL were included in this analysis. Estimated 10-year ASCVD risk was calculated for each participant and combined into three groups (5% to <7.5%, 7.5% to <20%, and ≥20%). Participants without data on medication use were excluded. Race and ethnicity were by self-report. The primary outcome, prevalence of statin use, was collected through pill bottle review.
Results:
A total of 3,417 participants were included in this study, representing 39.4 million US adults after applying sampling weights. The mean age was 61.8 (± 8.0) years. Of 3,417 included participants, 1,289 were women, and 2,128 were men. By self-report, 329 participants were Asian, 1,032 were Black, 786 were Hispanic, and 1,270 were White, for weighted percentages of 4.2%, 12.7%, 10.1%, and 73.0%, respectively. The proportion of participants with a 10-year predicted ASCVD risk of 5% to <7.5% was 31.0%, 7.5% to <20% was 58.3%, and ≥20% was 10.7%. Compared with White participants, statin use was lower in Black and Hispanic participants and comparable among Asian participants. A similar pattern was noted for each of the ASCVD risk strata. Within each race and ethnicity group, a graded increase in statin use was observed across increasing ASCVD risk strata. Statin use was low in the highest risk stratum overall, with significantly lower rates of use among Black (23.8%; prevalence ratio [PR], 0.90; 95% confidence interval [CI], 0.82-0.98 vs. White) and Hispanic participants (23.9%; PR, 0.90; 95% CI, 0.81-0.99 vs. White). Routine health care access and health insurance were significantly associated with higher statin use in Black, Hispanic, and White adults. The prevalence of statin use did not meaningfully change over time by race and ethnicity or by ASCVD risk stratum.
Conclusions:
The authors concluded that statin use for primary prevention of ASCVD was low among all race and ethnicity groups regardless of ASCVD risk, with the lowest use occurring among Black and Hispanic adults. Improvements in access to care may promote equitable use of primary prevention statins in Black and Hispanic adults.
Perspective:
These data suggest statin use is suboptimal for the primary prevention of ASCVD. Factors associated with statin use include insurance and location near health care facilities, suggesting access to preventive care is important. Given that ASCVD remains a leading cause of morbidity and mortality, improving access to preventive care, including statin prescriptions, is foundational for improving CV health.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Statins
Keywords: Atherosclerosis, Cholesterol, LDL, Diabetes Mellitus, Dyslipidemias, Ethnic Groups, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipoproteins, Prescriptions, Prevalence, Primary Prevention, Risk Factors
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