Variations statin prescribing pattern and LDL goal attainment for secondary prevention of atherosclerotic cardiovascular disease by language and race

Abstract

Background/Synopsis

Statin therapy is a well-established intervention to reduce the risk of recurrent atherosclerotic cardiovascular events. Recent studies have demonstrated statin prescription rates for primary and secondary prevention may be sub-optimal. There is limited information on how unmodifiable patient demographics—such as race and spoken language—affect statin prescribing and LDL-C goal attainment in patients with established CAD. Evaluating statin prescribing patterns and LCL-C target achievement across these demographics will help to identify areas for future intervention and to prevent further cardiovascular events equitably.

Objective/Purpose

Our study aims to determine whether the frequency of high intensity statin prescription and attainment of LDL-C < 70 mg/dL for secondary prevention of atherosclerotic cardiovascular disease differs as a function of spoken language and race/ethnicity amongst patients with documented coronary artery disease.

Methods

This is a retrospective case control study performed at a multi-site health system. Patients were included in the study if they were over the age of 18, attended an outpatient office encounter at a primary care or cardiovascular medicine office between 01/01/2023 and 09/30/2023 and had a documented diagnosis of coronary artery disease based on ICD-10 codes and billing data during this period.

Results

Among the 6,428 patients analyzed, 5,625 were Caucasian and 802 were non-Caucasian. The average LDL cholesterol (LDL-C) for Caucasian patients was 75.87 mg/dL, while for non-Caucasian patients it was 84.1 mg/dL (p-value of <0.001). Statin prescription rates were 70.86% for Caucasians and 65.89% for non-Caucasians (p = 0.004). Regarding language, 6,375 patients were English speakers and 185 were non-English speakers. The average LDL-C for English speakers was 76.85 mg/dL, compared to 79.41 mg/dL for non-English speakers (p = 0.444). Statin prescriptions were higher among English speakers than non-English speakers (70.45% vs 59.17%; p = 0.007).

Conclusions

Amongst patients with CAD, non-Caucasian patients and those whose primary language is anything other than English are less likely to achieve LDL-C levels < 70 mg/dL in accordance with ACC guidelines as compared to their English speaking or Caucasian counterparts. This may largely be related to variations in high intensity prescribing patterns between these groups. These findings highlight demographic disparities in LDL-C goal attainment and statin prescribing patterns, emphasizing the need for targeted interventions to improve cardiovascular care equity.