National Lipid Association

National Lipid Association

Source:

Ferdinand K. Session VII – Individual Health Inequities in the U.S. Presented at: National Lipid Association Scientific Sessions; Sept. 24-26, 2021; Orlando, Fla. (hybrid meeting).

Disclosures: Ferdinand reports consulting for Amgen, Medtronic and Novartis.
October 07, 2021
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CVD, cardiometabolic disparities ‘persistent and unacceptable’

Source:

Ferdinand K. Session VII – Individual Health Inequities in the U.S. Presented at: National Lipid Association Scientific Sessions; Sept. 24-26, 2021; Orlando, Fla. (hybrid meeting).

Disclosures: Ferdinand reports consulting for Amgen, Medtronic and Novartis.
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CVD and cardiometabolic disparities by race/ethnicity, geography and socioeconomic status are sizable, multifactorial and “persistent and unacceptable,” a speaker said during the National Lipid Association Scientific Sessions.

“We need to recognize and address the social determinants of health, we need to address the suboptimal care that’s being delivered in our populations. Every visit should be an opportunity to inform and educate patients and we should be more than just clinicians. We need to be advocates and help our patients assume practical steps and broad policy initiatives to overcome disparities in care,” Cardiology Today Editorial Board Member Keith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLA, professor of medicine, John W. Deming department of medicine, Tulane University School of Medicine, said during a presentation.

Graphical depiction of source quote presented in the article
Cardiology Today Editorial Board Member Keith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLA, professor of medicine, John W. Deming department of medicine, Tulane University School of Medicine.

Health, life expectancy and care have improved for Americans in the past 100 years, but a mortality gap between Black and white individuals has persisted since 1960, likely because compared with white Americans, Black Americans have higher risk for hypertension, diabetes, obesity, MI, stroke, chronic kidney disease, end-stage renal disease and CV mortality (particularly premature cardiac death), Ferdinand said.

“The difference in outcomes has been driven primarily by cardiovascular disease and cardiometabolic conditions,” Ferdinand said.

Disparities in life expectancy and other health outcomes “are mainly driven by a combination of low-income status, lack of identifiable sources of primary care and referral to specialists, low educational attainment, so patients have difficulty understanding how to navigate our very complicated health care delivery system and living conditions — ZIP codes have a profound effect on people’s outcomes, which may also reflect inadequate access to healthy foods,” he said.

The biggest drivers of clinical atherosclerotic CVD are poorly controlled risk factors, and those also appear to be major drivers of CVD disparities by race and ethnicity, he said, citing as an example the Southern diet, which is the largest mediator of the difference in hypertension between Black and white Americans.

Dyslipidemia is not the primary driver of the CVD mortality gap between Black and white Americans, but higher prevalence and poor management of other risk factors play a role, as do issues related to socioeconomic status such as lack of access to health care and lack of medication adherence, often driven by cost, Ferdinand said.

However, he said, lipoprotein(a) levels are nearly twofold higher in Black adults than in white adults, and are also high in South Asian adults.

He also noted triglyceride levels in people of African descent are not higher than in other individuals and do not explain CVD disparities in Black Americans. “Even with abdominal obesity and increased CVD risk, triglyceride levels may be relatively low, and we should be cautious in attributing the lower triglyceride levels to a sign of less insulin resistance and cardiovascular risk,” he said.

Diagnosis and treatment disparities are also a problem, he said, noting Black individuals have familial hypercholesterolemia (FH) diagnosed later than white individuals, and Black patients with FH are undertreated with statins.

He also noted women, patients from historically underrepresented backgrounds, patients with lower income levels and patients with lower educational levels are less likely to be approved for a PCSK9 inhibitor and less likely to fill their prescription if they are approved.

Steps that should be taken include to “reduce disparities in health care coverage and access to care,” Ferdinand said. “If a person does not have a robust form of health insurance, he or she will not be able to navigate our tortuous health care system. Access to care is not just insurance but having an identifiable source of primary care. And we need reduced disparities in the quality of care. Black and other minority patients consistently have less application of evidence-based care.”

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