A cohort study of statin prescribing among the uninitiated pre and post the 2013 ACC/AHA guideline change by race, ethnicity and language.

Abstract

Introduction: The 2013 American College of Cardiology (ACC)/ American Heart Association (AHA) guidelines to manage atherosclerotic cardiovascular disease (ASCVD) expanded eligibility for medication. To better understand the guidelines' impact on those who should have been on a statin all along, we performed a cohort study of patients eligible-for-but-never-prescribed statins before the guideline change, evaluating statin eligibility or prescription after the guideline change by race, ethnicity, and preferred language.

Methods: We used 2012-2020 electronic health record data from low-income patients in community health centers (CHCs) in 14 states to evaluate statin eligibility and prescriptions in patients aged 40-75 years, using multivariable generalized estimating equation logistic regression, accounting for clustering of patients within clinics, adjusted for patient demographics, overall healthcare utilization, and comorbidities.

Results: In our sample (N=13,669), Black and most Latino patients were more likely eligible for statins post-guideline change than non-Hispanic whites. All minority groups in our study (except English-preferring Latino patients ≤ 65) were more likely than white adults to receive a statin post-guideline change if eligible. Spanish-preferring Latino patients had the highest prevalence of statin prescriptions. Patients age ≥65 had high eligibility (85% overall), but a statin prescription prevalence of 50% overall.

Conclusion: In CHCs, racial and ethnic minority patients, especially Spanish-preferring Latinos, may receive statin prescriptions more than white patients. Further work can help elucidate these trends to aid physicians in effectively and equitably managing ASCVD risk across minority populations as they age.