June 13, 2018
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Black patients less likely to receive statins

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Guideline-recommended statin therapy was less likely to be given to black patients compared with other races and ethnicities, according to a study published in JAMA Cardiology.

“While improving racial disparities may help reduce the burden of [atherosclerotic] CVD in African-American patients, most African-American and white patients were not receiving guideline-appropriate statin therapy,” Michael G. Nanna, MD, trainee of cardiovascular medicine at Duke University School of Medicine, and colleagues wrote. “Greater emphasis on following national guidelines when treating both African-American patients and white patients may improve care and outcomes for all patients.”

PALM registry data

Researchers assessed data from 5,689 patients (14.2% black) from the PALM registry with atherosclerotic CVD or at high risk for it. Information was collected from 138 cardiology, primary care and endocrinology practices in 2015 and included clinical data and current statin use.

Patients also completed a survey at enrollment on education level, race, socioeconomic status and beliefs about cholesterol, statins, clinician trust and atherosclerotic CVD. All patients underwent measurements of core laboratory lipid panels.

Patients in this analysis were white (median age, 68 years) or black (median age, 64 years) and were recommended for statin therapy according to the 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.

Compared with white patients, black patients were less likely to be treated with any statin (70.61% vs. 74.85%; P = .02) and to receive a statin at an intensity recommended by guidelines (33.3% vs. 43.9%; P < .001). After adjusting for clinical and demographic factors, the RR was no longer statistically significant (RR = 1.07; 95% CI, 1-1.15).

Black patients who were treated with statins had a higher LDL compared with white patients who were treated with statins (97 mg/dL vs. 85 mg/dL; P < .001).

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Clyde W.Yancy, MD, MSc
Clyde W. Yancy

Beliefs on statins

Fewer black patients believed that statins were safe vs. white patients (36.2% vs. 57.3%; P < .001). Black patients were also less likely to believe that statin therapy was effective (70% vs. 74.4%; P = .008) and to trust their clinician (82.3% vs. 93.8%; P < .001).

After adjustment for clinical, demographic and clinician factors, in addition to patient beliefs and socioeconomic status, there were no significant group differences regarding undertreatment with statins (adjusted RR = 1.03; 95% CI, 0.96-1.11).

“Medical mistrust among African-American patients for nonstatin-based clinical decisions has been previously documented, representing an important challenge for both clinicians and patients,” Nanna and colleagues wrote. “Trust-building in clinical practice settings is more difficult than ever because shorter office visits and electronic medical records consume clinicians’ attention, but the process remains crucial to the implementation and efficacy of educational efforts. Medical mistrust may also be influenced by poor clinician communication. The psychological, cultural and community aspects that may contribute to differences in statin beliefs and clinician trust, as well as their potential influence on statin use, merit further investigation.”

In an editor’s note, Clyde W. Yancy, MD, MSc, vice dean for diversity and inclusion, chief of cardiology in the department of medicine, Magerstadt Professor and professor of medicine and medical social sciences at Northwestern University Feinberg School of Medicine, and past president of the American Heart Association, wrote: “Were these additional data addressing perceptions, beliefs and clinician characteristics unavailable, this would have been yet another article declaring the presence of an unacceptable health care disparity. Instead, this study gets us closer to the truth and to actionable directions. Consistent clinical decision-making, managing trust and emphasizing patient education regardless of the patient cohort should be our unyielding clinical priorities.” – by Darlene Dobkowski

Disclosures: Nanna and Yancy report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.