Disparities in statin use following identification of coronary artery calcium

Abstract

Background: Coronary artery calcium (CAC) scoring is a useful tool for risk stratification in asymptomatic individuals, and current clinical practice is to utilize statins in individuals with CAC. A growing body of research has aimed to identify and mitigate health disparities and their relation to cardiovascular disease (CVD) risk. Likewise, studies have highlighted social determinants of health (SDOH) that contribute to health disparities in CVD.

Objectives: We aimed to evaluate whether disparities exist with regards to statin use after identification of CAC within the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: The associations between race/ethnicity, age, sex, primary language, and an aggregate SDOH score (calculated using previously defined methods) with statin use at short- and long-term follow-up were evaluated in logistic regression models with adjustment for traditional CVD risk factors in individuals with baseline CAC>0 without baseline statin use.

Results: In the overall cohort, 3416 participants had CAC = 0, 1794 CAC 1-99, 757 CAC 100-300, and 847 CAC>300 AU Mean age was 62 (10.2) years, 53 % (n = 3601) were women, 38.5 % (n = 2622) were non-Hispanic White, 27.8 % (n = 1892) were non-Hispanic Black, 22.0 % (n = 1892) were Hispanic and 11.8 % (n = 1892) were Chinese. At short-term follow up (median 1.6 years, n = 2665), those with a higher SDOH score (worse burden) (OR 0.39, 95 % CI 0.16-0.91), Hispanic (OR 0.59, 95 % CI 0.40-0.85) and Spanish speaking individuals (OR 0.51, 95 % CI 0.30-0.83) were less likely to report statin use following CAC identification. At long-term follow up (median 9.4 years, n = 2533), Black individuals (OR 0.71, 95 % CI 0.52-0.96), Chinese (OR 0.58, 95 % CI 0.39-0.86) and Chinese speaking individuals (OR 0.50, 95 % CI 0.33-0.76) were also less likely to report statin use following CAC identification, and a trend was noted for SDOH score (OR 0.53, 95 % CI 0.26-1.09).

Conclusions: This study identifies disparities in statin use by race/ethnicity, language, and social determinants of health after identification of CAC. While CAC is an effective tool for identifying atherosclerosis in asymptomatic individuals, more equitable use of subsequent therapy is needed.

Keywords: Coronary artery calcium; Disparities; Statin.

Central Illustration.

Fig. 1

Components of the SDOH Aggregate Score.

Fig. 2

Flow diagram of participant exclusion criteria.

Fig. 3

Prevalence of statin use at follow-up by race/ethnicity, language, and social determinants of health. p < 0.001 for race/ethnicity and language at long-term follow-up.

Fig. 4

Social determinants of health and statin use at follow-up exams. Adjusted for traditional risk factors (age, sex, BMI, SBP, total cholesterol, HDL-C, diabetes mellitus, smoking status, use of anti-hypertensive medications). Abbreviations per Table 1.