A Cohort Study of Statin Prescribing Among the Uninitiated Before and After the 2013 ACC/AHA Guideline Change by Race, Ethnicity and Language.

Abstract

The 2013 American College of Cardiology and the American Heart Association guidelines to manage atherosclerotic cardiovascular disease expanded eligibility for medication. To better understand the guidelines' impact on those who should have been on a statin all along, the authors performed a cohort study of patients who were eligible for, but were never prescribed, statins before the guideline change, evaluating statin eligibility or prescription after the guideline change by race, ethnicity, and preferred language. The study used electronic health records from 2012 to 2020 of low-income patients in community health centers in 14 states to evaluate statin eligibility and prescriptions in patients aged 40-75 years. It used multivariable generalized estimating equation logistic regression, accounting for clustering of patients within clinics, adjusted for patient demographics, overall healthcare utilization, and comorbidities. In the study sample (N=13,669), Black and most Latino patients were more likely to be eligible for statins post-guideline change than non-Hispanic White patients. All minority groups in the study (except English-preferring Latino patients ≤65 years) were more likely than White adults to receive a statin post-guideline change if eligible. Spanish-preferring Latino patients had the highest prevalence of statin prescriptions. Patients aged ≥65 years had high eligibility (85% overall) but a statin prescription prevalence of 50% overall. In community health centers, racial and ethnic minority patients, especially Spanish-preferring Latinos, may receive statin prescriptions more than White patients. Further studies could understand these trends to aid physicians in effectively and equitably managing atherosclerotic cardiovascular disease risk across minority populations as they age.