Racial disparities in LDL-C control, ASCVD risk reclassification by statin use, coronary artery calcium scores, and the Pooled Cohort Equation

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.066

Benjamin Hsieh MD, Lorenzo Cotugno MD, Sana Saeed MD, Ethan Swartz MD, Prit Patel DO

{"title":"Racial disparities in LDL-C control, ASCVD risk reclassification by statin use, coronary artery calcium scores, and the Pooled Cohort Equation","authors":"Benjamin Hsieh MD, Lorenzo Cotugno MD, Sana Saeed MD, Ethan Swartz MD, Prit Patel DO","doi":"10.1016/j.jacl.2025.04.066","DOIUrl":null,"url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>ASCVD is a leading cause of morbidity and mortality, with LDL-C control essential for prevention. Significant racial disparities exist in LDL-C control, statin adherence, and ASCVD risk assessment. The Pooled Cohort Equation (PCE) estimates risk but may lack precision for racial minorities. Adding Coronary Artery Calcium Score (CACS) can refine risk stratification, but its impact on reclassification across racial groups, combined with statin adherence, is not well understood. This study addresses these gaps to improve risk assessment and reduce disparities.</div></div><div><h3>Objective/Purpose</h3><div>This study examines the interplay between LDL-C control, statin adherence, CACS, and the PCE in refining ASCVD risk stratification across racial groups. It aims to explore how CACS and PCE contribute to risk reclassification, focusing on the role of statin therapy.</div></div><div><h3>Methods</h3><div>A retrospective cohort of adults aged 40–75 without CAD from the MESA study was analyzed. Participants with complete data on LDL-C, statin use, CACS, and PCE variables (age, gender, race, blood pressure, diabetes, smoking, and cholesterol) were included. LDL-C control, statin use, and PCE-based risk were compared by race. ASCVD risk reclassification by CACS (0, 1–99, ≥ 100 HU) was assessed alongside PCE, stratified by statin adherence. Multivariable models evaluated interactions between race, statin use, CACS, and risk reclassification.</div></div><div><h3>Results</h3><div>The study included 3,282 participants. Whites exhibited the highest LDL-C control rates (mean LDL-C: 105.3 mg/dL), followed by Asians (115.6 mg/dL), Blacks (120.2 mg/dL), and Hispanics (125.4 mg/dL). Statin adherence varied significantly, with Whites showing the highest adherence rates (65%), compared to 52% in Blacks and 48% in Hispanics. CACS and PCE-based risk estimates demonstrated racial disparities, with 31.6% of Blacks having CACS = 0 compared to 31.6% of Whites. Reclassification of ASCVD risk by combining PCE and CACS led to a reduction in predicted risk for 15% of Black participants compared to 10% of Whites. Statin therapy improved CACS- and PCE-based reclassification consistency, especially among racial minorities. Interaction models demonstrated that LDL-C control, PCE-estimated risk, and statin adherence significantly influenced reclassification outcomes, with race modifying these effects.</div></div><div><h3>Conclusions</h3><div>Racial disparities in LDL-C control, statin adherence, and CACS distribution affect PCE-based ASCVD risk estimation. Incorporating CACS and PCE improves stratification, especially for minorities. These findings underscore the importance of integrating statin adherence, PCE, and advanced imaging techniques into personalized risk assessment strategies. Further research should assess the long-term clinical impact.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e50"},"PeriodicalIF":3.6000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical lipidology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1933287425001424","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}

引用次数: 0

Abstract

Background/Synopsis

ASCVD is a leading cause of morbidity and mortality, with LDL-C control essential for prevention. Significant racial disparities exist in LDL-C control, statin adherence, and ASCVD risk assessment. The Pooled Cohort Equation (PCE) estimates risk but may lack precision for racial minorities. Adding Coronary Artery Calcium Score (CACS) can refine risk stratification, but its impact on reclassification across racial groups, combined with statin adherence, is not well understood. This study addresses these gaps to improve risk assessment and reduce disparities.

Objective/Purpose

This study examines the interplay between LDL-C control, statin adherence, CACS, and the PCE in refining ASCVD risk stratification across racial groups. It aims to explore how CACS and PCE contribute to risk reclassification, focusing on the role of statin therapy.

Methods

A retrospective cohort of adults aged 40–75 without CAD from the MESA study was analyzed. Participants with complete data on LDL-C, statin use, CACS, and PCE variables (age, gender, race, blood pressure, diabetes, smoking, and cholesterol) were included. LDL-C control, statin use, and PCE-based risk were compared by race. ASCVD risk reclassification by CACS (0, 1–99, ≥ 100 HU) was assessed alongside PCE, stratified by statin adherence. Multivariable models evaluated interactions between race, statin use, CACS, and risk reclassification.

Results

The study included 3,282 participants. Whites exhibited the highest LDL-C control rates (mean LDL-C: 105.3 mg/dL), followed by Asians (115.6 mg/dL), Blacks (120.2 mg/dL), and Hispanics (125.4 mg/dL). Statin adherence varied significantly, with Whites showing the highest adherence rates (65%), compared to 52% in Blacks and 48% in Hispanics. CACS and PCE-based risk estimates demonstrated racial disparities, with 31.6% of Blacks having CACS = 0 compared to 31.6% of Whites. Reclassification of ASCVD risk by combining PCE and CACS led to a reduction in predicted risk for 15% of Black participants compared to 10% of Whites. Statin therapy improved CACS- and PCE-based reclassification consistency, especially among racial minorities. Interaction models demonstrated that LDL-C control, PCE-estimated risk, and statin adherence significantly influenced reclassification outcomes, with race modifying these effects.

Conclusions

Racial disparities in LDL-C control, statin adherence, and CACS distribution affect PCE-based ASCVD risk estimation. Incorporating CACS and PCE improves stratification, especially for minorities. These findings underscore the importance of integrating statin adherence, PCE, and advanced imaging techniques into personalized risk assessment strategies. Further research should assess the long-term clinical impact.

查看原文本刊更多论文

LDL-C控制的种族差异、他汀类药物使用对ASCVD风险的重新分类、冠状动脉钙评分和合并队列方程

背景/内容ascvd是发病率和死亡率的主要原因，控制LDL-C是预防ascvd的关键。在LDL-C控制、他汀类药物依从性和ASCVD风险评估方面存在显著的种族差异。汇集队列方程（PCE）估计了少数种族的风险，但可能缺乏准确性。添加冠状动脉钙评分（CACS）可以细化风险分层，但其对跨种族重新分类的影响，以及他汀类药物的依从性，尚不清楚。这项研究解决了这些差距，以改善风险评估和减少差距。目的/目的本研究探讨LDL-C控制、他汀类药物依从性、CACS和PCE在改善不同种族人群ASCVD风险分层中的相互作用。该研究旨在探讨CACS和PCE如何促进风险重新分类，重点关注他汀类药物治疗的作用。方法对MESA研究中40 ~ 75岁无CAD的成年人进行回顾性队列分析。纳入具有LDL-C、他汀类药物使用、CACS和PCE变量（年龄、性别、种族、血压、糖尿病、吸烟和胆固醇）完整数据的参与者。LDL-C控制、他汀类药物使用和基于pce的风险按种族进行比较。通过CACS（0,1 - 99,≥100 HU）评估ASCVD风险再分类，并根据他汀类药物依从性进行PCE分层。多变量模型评估了种族、他汀类药物使用、CACS和风险重新分类之间的相互作用。结果该研究包括3282名参与者。白人表现出最高的LDL-C控制率（平均LDL-C: 105.3 mg/dL），其次是亚洲人（115.6 mg/dL），黑人（120.2 mg/dL）和西班牙裔（125.4 mg/dL）。他汀类药物的依从性差异很大，白人的依从率最高（65%），黑人为52%，西班牙裔为48%。基于CACS和pce的风险估计显示了种族差异，31.6%的黑人患有CACS = 0，而白人为31.6%。通过结合PCE和CACS对ASCVD风险进行重新分类，导致15%的黑人参与者的预测风险降低，而10%的白人参与者的预测风险降低。他汀类药物治疗提高了基于CACS和pce的再分类一致性，特别是在少数种族中。相互作用模型表明LDL-C控制、pce估计的风险和他汀类药物依从性显著影响重分类结果，种族改变了这些影响。结论LDL-C控制、他汀类药物依从性和CACS分布的种族差异影响基于pce的ASCVD风险估计。结合CACS和PCE可以改善分层，特别是对少数民族。这些发现强调了将他汀类药物依从性、PCE和先进成像技术整合到个性化风险评估策略中的重要性。进一步的研究应评估长期临床影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.