Black and Hispanic adults in the US are less likely than White adults to get statins, medications that prevent or treat common forms of heart disease, according to a new study.
For the study, published Wednesday in the journal JAMA Cardiology, the researchers analyzed data on more than 3,000 people ages 40 through 75 in the United States, broken down by their risk of developing atherosclerotic cardiovascular disease, also known as ASCVD, over a 10-year period. Just over 10.7% were in the highest-risk group, with a risk at or above 20%.
Overall statin use was low – just 25.5% of all participants – but statin use went up with ASCVD risk.
“Black and Hispanic adults had the lowest use rates across all risk strata compared with White adults,” the researchers wrote. The disparities were especially pronounced in the highest-risk group, with 23.8% of Black participants and 23.9% of Hispanic participants using statins, compared with 37.6% of White participants.
ASCVD is caused by plaque building up in the arteries of the heart and includes conditions like heart attack, stroke and aneurysm, according to the American Heart Association. It’s the leading cause of death among adults in the US, the study notes.
Statins are commonly prescribed to lower levels of “bad” cholesterol in the blood, the US Centers for Disease Control and Prevention says. Statins are most effective in people who have a 5% to 20% risk of ASCVD in the next 10 years because of things like high blood pressure, diabetes or an unhealthy lifestyle.
Statins are effective both to prevent cardiovascular disease and to lower its impact in people who have it, said Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease at NYU Langone, who was not involved in the new study.
Cardiovascular disease is more common among Black adults. According to the Cleveland Clinic, 47% of Black adults have been diagnosed with cardiovascular disease, compared with 36% of White adults.
Black adults are also 30% more likely to die from cardiovascular disease than White adults, according to the US Department of Health and Human Services.
“It is well-established that there is a disparity by race that exists in cardiovascular outcomes,” said study co-author Dr. Ambarish Pandey, an associate professor of internal medicine in the Division of Cardiology at the University of Texas Southwestern Medical Center.
“Making sure that we can improve access to care and opportunities to get … on medications like statins is key to reduce the disparities,” he said.
There were two notable drivers of disparities noted in the study: routine health care access and health insurance status.
If a participant had seen any clinician within the previous 12 months, they were classified as having routine health care access, said Joshua Jacobs, an author of the study and a cardiology clinical pharmacist at University of Utah Health.
About 89% of Black participants in the highest-risk group had routine health care access, as did 85% of the Hispanic participants and 95% of the White participants.
Health insurance levels also differed: About 85% of the Black participants, 88.9% of the Hispanic participants and 96.7% of the White participants had health insurance.
The drivers of the disparities are nuanced, though, Jacobs said.
“Someone having health insurance isn’t necessarily an absolute capture of someone’s access to health care,” he said. “Someone who doesn’t have insurance may not be employed or may not have a full-time job, and that comes with its own health risks. … It is hard to say that these two things would be the sole drivers.”
The researchers say the study makes the need for intentional next steps clear.
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Jacobs called for the development of wider community-based care.
“There needs to be more targeted therapies, not necessarily from just clinicians or just patients, but a comprehensive group of patients, clinicians, policymakers, to really target these health disparities that are pervasive,” he said.
Weintraub also noted a need to make statins more accessible.
“Find out where these people are, and rather than getting them to come to you, you go to them,” he said. “You figure out a way to be able to screen them in an efficient and inexpensive manner, and treat them as necessary.”