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. 2023 May 1;8(5):443-452.
doi: 10.1001/jamacardio.2023.0228.

Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US: National Health and Nutrition Examination Surveys, 2013 to March 2020

Joshua A Jacobs  1 , Daniel K Addo  1 , Alexander R Zheutlin  2 , Catherine G Derington  1 , Utibe R Essien  3   4 , Ann Marie Navar  5   6 , Inmaculada Hernandez  7 , Donald M Lloyd-Jones  8 , Jordan B King  1   9 , Shreya Rao  5 , Jennifer S Herrick  10 , Adam P Bress  1 , Ambarish Pandey  5
Affiliations

Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US: National Health and Nutrition Examination Surveys, 2013 to March 2020

Joshua A Jacobs et al. JAMA Cardiol. .

Erratum in

  • Error in Figure.
    [No authors listed] [No authors listed] JAMA Cardiol. 2023 Jul 1;8(7):710. doi: 10.1001/jamacardio.2023.1358. JAMA Cardiol. 2023. PMID: 37223916 Free PMC article. No abstract available.

Abstract

Importance: The burden of atherosclerotic cardiovascular disease (ASCVD) in the US is higher among Black and Hispanic vs White adults. Inclusion of race in guidance for statin indication may lead to decreased disparities in statin use.

Objective: To evaluate prevalence of primary prevention statin use by race and ethnicity according to 10-year ASCVD risk.

Design, setting, and participants: This serial, cross-sectional analysis performed in May 2022 used data from the National Health and Nutrition Examination Survey, a nationally representative sample of health status in the US, from 2013 to March 2020 (limited cycle due to the COVID-19 pandemic), to evaluate statin use for primary prevention of ASCVD and to estimate 10-year ASCVD risk. Participants aged 40 to 75 years without ASCVD, diabetes, low-density lipoprotein cholesterol levels 190 mg/dL or greater, and with data on medication use were included.

Exposures: Self-identified race and ethnicity (Asian, Black, Hispanic, and White) and 10-year ASCVD risk category (5%-<7.5%, 7.5%-<20%, ≥20%).

Main outcomes and measures: Prevalence of statin use, defined as identification of statin use on pill bottle review.

Results: A total of 3417 participants representing 39.4 million US adults after applying sampling weights (mean [SD] age, 61.8 [8.0] years; 1289 women [weighted percentage, 37.8%] and 2128 men [weighted percentage, 62.2%]; 329 Asian [weighted percentage, 4.2%], 1032 Black [weighted percentage, 12.7%], 786 Hispanic [weighted percentage, 10.1%], and 1270 White [weighted percentage, 73.0%]) were included. Compared with White participants, statin use was lower in Black and Hispanic participants and comparable among Asian participants in the overall cohort (Asian, 25.5%; Black, 20.0%; Hispanic, 15.4%; White, 27.9%) and within ASCVD risk strata. Within each race and ethnicity group, a graded increase in statin use was observed across increasing ASCVD risk strata. Statin use was low in the highest risk stratum overall with significantly lower rates of use among Black (23.8%; prevalence ratio [PR], 0.90; 95% CI, 0.82-0.98 vs White) and Hispanic participants (23.9%; PR, 0.90; 95% CI, 0.81-0.99 vs White). Among other factors, routine health care access and health insurance were significantly associated with higher statin use in Black, Hispanic, and White adults. Prevalence of statin use did not meaningfully change over time by race and ethnicity or by ASCVD risk stratum.

Conclusions and relevance: In this study, statin use for primary prevention of ASCVD was low among all race and ethnicity groups regardless of ASCVD risk, with the lowest use occurring among Black and Hispanic adults. Improvements in access to care may promote equitable use of primary prevention statins in Black and Hispanic adults.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Derington reports research funds to her institution from Amarin Pharma. Dr Navar reported grants from Bristol Myers Squibb, Esperion, Amgen, and Janssen and personal fees from AstraZeneca, Boehringer Ingelheim Bayer, Janssen, Eli Lilly, Novo Nordisk, Novartis, New Amsterdam, Cerner, and Pfizer outside the submitted work. Dr Hernandez reported consulting fees from Pfizer and Bristol Myers Squibb and is supported by the National Heart, Lung, and Blood institute. Dr Lloyd-Jones reported serving as an unpaid fiduciary officer of the American Heart Association. Dr King is supported by the National Heart, Lung, and Blood institute. Dr Bress reports research funds to his institution from Amarin Pharma and Amgen and consultant work for Amarin Pharma. Dr Pandey reported research support from the Gilead Sciences Research Scholar Program, the National Institute on Aging GEMSSTAR grant, and the National Institute on Minority Health and Disparities; grant funding outside the submitted work from Applied Therapeutics and Myovista; honoraria outside the submitted work for serving as an advisor/consultant for Tricog Health, Eli Lilly, Cytokinetics, Rivus, Roche Diagnostics, Pieces Technologies, Palomarin, Emmi Solutions, and Axon; and nonfinancial support from Pfizer and Merck. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Inclusion and Exclusion Criteria
ASCVD indicates atherosclerotic cardiovascular disease; LDL-C, low-density lipoprotein cholesterol; NHANES, National Health and Nutrition Examination Surveys.
Figure 2.
Figure 2.. Prevalence of Statin Use Among Participants in the 2013-March 2020 National Health and Nutrition Examination Surveys Meeting Criteria for Primary Prevention Based on Predicted 10-Year Risk of Atherosclerotic Cardiovascular Disease (ASCVD)
Data represented as prevalence ratios with 95% CIs.
Figure 3.
Figure 3.. Temporal Trends in Prevalence of Statin Use Among Participants in the 2013-March 2020 National Health and Nutrition Examination Surveys (NHANES) Meeting Criteria for Primary Prevention
Data represented as odds ratios and 95% CIs with NHANES cycle 2013-2014 as the reference cycle.
See this image and copyright information in PMC

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