Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US

Abstract

ImportanceThe burden of atherosclerotic cardiovascular disease (ASCVD) in the US is higher among Black and Hispanic vs White adults. Inclusion of race in guidance for statin indication may lead to decreased disparities in statin use.ObjectiveTo evaluate prevalence of primary prevention statin use by race and ethnicity according to 10-year ASCVD risk.Design, Setting, and ParticipantsThis serial, cross-sectional analysis performed in May 2022 used data from the National Health and Nutrition Examination Survey, a nationally representative sample of health status in the US, from 2013 to March 2020 (limited cycle due to the COVID-19 pandemic), to evaluate statin use for primary prevention of ASCVD and to estimate 10-year ASCVD risk. Participants aged 40 to 75 years without ASCVD, diabetes, low-density lipoprotein cholesterol levels 190 mg/dL or greater, and with data on medication use were included.ExposuresSelf-identified race and ethnicity (Asian, Black, Hispanic, and White) and 10-year ASCVD risk category (5%-<7.5%, 7.5%-<20%, ≥20%).Main Outcomes and MeasuresPrevalence of statin use, defined as identification of statin use on pill bottle review.ResultsA total of 3417 participants representing 39.4 million US adults after applying sampling weights (mean [SD] age, 61.8 [8.0] years; 1289 women [weighted percentage, 37.8%] and 2128 men [weighted percentage, 62.2%]; 329 Asian [weighted percentage, 4.2%], 1032 Black [weighted percentage, 12.7%], 786 Hispanic [weighted percentage, 10.1%], and 1270 White [weighted percentage, 73.0%]) were included. Compared with White participants, statin use was lower in Black and Hispanic participants and comparable among Asian participants in the overall cohort (Asian, 25.5%; Black, 20.0%; Hispanic, 15.4%; White, 27.9%) and within 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% CI, 0.82-0.98 vs White) and Hispanic participants (23.9%; PR, 0.90; 95% CI, 0.81-0.99 vs White). Among other factors, routine health care access and health insurance were significantly associated with higher statin use in Black, Hispanic, and White adults. Prevalence of statin use did not meaningfully change over time by race and ethnicity or by ASCVD risk stratum.Conclusions and RelevanceIn this study, 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.

Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients

“…Although the time-averaged difference in LDL-C over the duration of the trial was moderate (23.2 mg/dL [16.3%]), there were substantial reductions in major adverse cardiovascular outcomes and cardiovascular and all-cause mortality. These findings emphasize the potential value of lipid-modulating therapy in patients who have had no prior cardiovascular event but who have a high risk for a first event, a population that is currently undertreated . Because diabetes was an enrollment criterion for increased cardiovascular risk, approximately two-thirds of the participants had previously diagnosed diabetes.…”

“…In a registry that studied reasons why eligible patients were not taking a statin, 59% reported never being offered treatment, 10% declined a statin, and 31% discontinued therapy . Statin use in primary prevention patients was particularly low in minority groups in a recent national survey . Current guidelines do not specifically address the use of nonstatin treatments in high-risk primary prevention patients.…”

“…Recent data are limited on the effects of statins or other adjunctive treatments in patients without a history of a cardiovascular event, leading some authors to question whether the benefits of cholesterol lowering exceed the harms in these patients . Currently, lipid-lowering therapies are underutilized in high-risk primary prevention patients, particularly women and patients from racial and ethnic minority populations . More than half of eligible patients do not currently receive lipid-lowering therapies …”

Error in Figure

“…The Original Investigation titled “Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US: National Health and Nutrition Examination Surveys, 2013 to March 2020,” published on March 22, 2023, was corrected to fix mislabeled exclusions shown in Figure 1. This article was corrected online.…”

Bempedoic Acid for Primary Prevention of Cardiovascular Events—Reply

“…Although absolute event rates are lower in primary compared with secondary prevention, the treatment effects appear to be larger in the CLEAR Outcomes and other trials. Unfortunately, in the absence of contemporary trials for primary prevention, this group is undertreated …”