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On March 23, 2023, we reported on a study published in JAMA Cardiology that evaluated the prevalence of primary prevention statin use by race and ethnicity according to 10-year atherosclerotic cardiovascular disease (ASCVD) risk.
Investigators pooled participant data for 3 National Health and Nutrition Examination Surveys (NHANES) cycles between 2013 and 2020. The team calculated 10-year predicted ASCVD risk using the pooled cohort equation (PCE) and divided the risk into categories: 5% to <7.5%, 7.5% to <20%, and ≥20%. A total of 11 536 participants aged 40 to 75 years who self-identified as Asian, Black, Hispanic, or White were assessed for inclusion. The primary outcome was the prevalence of statin use, defined as the identification after interviewer pill bottle review. For the primary analysis, Poisson regression with adjustment for NHANES cycle was used to determine the association of race and ethnicity and ASCVD risk stratum with statin use.
The final cohort for analysis comprised 3417 participants, representing 39.4 million US adults after weight-based sampling. There were 1289 women and 2128 men with an average age of 61.8 years. Based on self-report, 329 participants were Asian (weighted percentage, 4.2%), 1032 were Black (12.7%), 786 were Hispanic (10.1%), and 1270 were White (73.0%). 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%.
When investigators compared statin use among racial and ethnic groups, overall prevalence was 25.5% (95% CI, 23.3 - 27.9). Use of the drugs was significantly lower among Black and Hispanic participants vs White participants in the overall cohort (20.0% vs 27.9%, P<.001, and 15.4% vs 27.9%, P<.001, respectively) as well as across ASCVD risk strata. The analysis found no difference in overall statin use between Asian and White participants (25.5% vs 27.9%; PR, 0.98; 95% CI, 0.94-1.02; P=.38) or within each ASCVD risk strata.
While the investigators observed a graded increase in the prevalence of statin use across ASCVD risk strata within each race and ethnicity group, statin use in the highest risk strata (≥20%) was low overall and was significantly lower among Black participants (23.8; prevalence ratio [PR], 0.90; 95% [CI, 0.82 - 0.98) and Hispanic participants (23.9%; PR, 0.90; 95% CI, 0.81 - 0.99) compared with White participants (37.6%; reference group).
Note from authors
"These findings demonstrate the persistent racial and ethnic disparities in guideline-recommended statin use for primary prevention among at-risk adults and represent an opportunity to advance pharmacoequity in primary prevention."