Effects of Race on Statin Prescribing for Primary Prevention With High Atherosclerotic Cardiovascular Disease Risk in a Large Healthcare System

Abstract

Background: Although guidelines recommend statins with a high level of evidence for 4 primary prevention benefit groups, prescribing disparities still exist. The objective of this study was to evaluate the effects of race on statin prescribing for primary prevention. Methods and Results: A retrospective cohort analysis of patients within a large academic health system was performed to investigate statin prescribing among primary prevention groups. The statin benefits groups were patients diagnosed with diabetes mellitus, with an low-density lipoprotein ≥190 mg/dL, or with an atherosclerotic cardiovascular disease (ASCVD) 10-year risk ≥7.5%. Statin prescribing was 20% in the ASCVD ≥7.5% group, followed by 37.8% in the low-density lipoprotein ≥190 mg/dL group and 40.5% in the diabetes mellitus group. Blacks were less likely to be prescribed a statin compared with whites in the diabetes mellitus (odds ratio, 0.64; 95% CI, 0.49–0.82; P=0.001) and ASCVD ≥7.5% groups (odds ratio, 0.38; 95% CI, 0.26–0.54; P<0.0001). Blacks 60 to 69 years of age (odds ratio, 7.97; 95% CI, 3.14–20.2; P=0.003) and 70 to 79 years of age (odds ratio, 4.21; 95% CI, 1.81–9.79; P=0.008) were more likely to be prescribed a statin compared with blacks <60 years of age in the ASCVD ≥7.5% group. Conclusions: Blacks are less likely to be prescribed statins in diabetes mellitus and ASCVD ≥7.5% groups compared with whites. Younger blacks with ASCVD risk ≥7.5% are less likely to be prescribed statins compared with older blacks. Future research should focus on tailored interventions to address statin prescribing disparities in blacks.