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. 2025 Mar 28:22:100959.
doi: 10.1016/j.ajpc.2025.100959. eCollection 2025 Jun.

Disparities in statin use in patients with ASCVD with vs without rheumatologic diseases in a large integrated healthcare system: Houston methodist CVD learning health system registry

Eleonora Avenatti  1 , Helene DiGregorio  2 , Elia El Hajj  2 , Rakesh Gullapelli  3 , Kenneth Williams  2 , Izza Shahid  3 , Budhaditya Bose  3 , Kobina Hagan  3 , Juan C Nicolas  3 , Shubham Lahan  3 , Nwabunie Nwana  3 , Sara Ayaz Butt  3 , Kanika Monga  4 , Lily Anne Romero Karam  4 , Myriam Guevara  4 , Zulqarnain Javed  3 , Brittany Weber  5 , Sadeer Al-Kindi  1   3 , Khurram Nasir  1   3
Affiliations

Disparities in statin use in patients with ASCVD with vs without rheumatologic diseases in a large integrated healthcare system: Houston methodist CVD learning health system registry

Eleonora Avenatti et al. Am J Prev Cardiol. .

Abstract

Objective: The comorbid presence of Rheumatologic Diseases (RDs) and Atherosclerotic Cardiovascular Disease (ASCVD) substantially accentuates cardiovascular risk. We aimed to compare rates of secondary prevention statin utilization in patients with established ASCVD both with and without underlying comorbid RDs- and to highlight any potential gender, racial, or ethnic disparities in statin use in a contemporary US cohort.

Methods: We queried the electronic medical record (EHR)-linked Houston Methodist Learning Health System Outpatient Registry containing data for approximately 1.2 million patients to identify patients with diagnosed ASCVD and RDs using ICD-10 codes. Statin prescription rates and dosage were evaluated via ATC codes.

Results: Among 113,021 patients with ASCVD, 7286 (6.4 %) had comorbid RDs. The majority (71.1 %) of patients with ASCVD were prescribed statins, with discernibly lower utilization in patients with comorbid RDs compared to the non-RD population (63.2 % vs. 71.7 %, p < 0.005). High-intensity statins were prescribed in 42,636 (37.7 %) of ASCVD patients, with similarly reduced utilization in RD vs non-RD patients (30.4 % vs. 38.2 %). These trends remained consistent across sociodemographic subgroups. Moreover, women were consistently less likely to receive high intensity statins in both RD and non-RD groups. Reduced statin utilization was not accounted for with non-statin lipid lowering therapies in RD vs non RD subgroups.

Conclusion: In this real-world study, co-morbid RDs were associated with significant lower utilization of secondary prevention statin therapy in patients with ASCVD. A multidisciplinary team approach may help to better understand key drivers of statin uptake in this clinically vulnerable population.

Keywords: Cardio-rheumatology; Cardiovascular disease; Cardiovascular risk; Gender disparities; Health equity; Rheumatological disorders; Statins.

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Conflict of interest statement

The authors declare that they have no conflicts of interest relevant to the content of this manuscript.

Figures

Fig. 1
Fig. 1
Flowchart detailing inclusion of study population based on eligibility criteria. HM, Houston Methodist; ASCVD, Atherosclerotic Cardiovascular Disease.
Fig. 2
Fig. 2
Utilization of Statins in Patients with Atherosclerotic Cardiovascular Disease across age strata, gender and racial/ethnic subgroups, stratified by RD status. RDs include Rheumatoid arthritis (RA), Juvenile RA, Psoriatic Arthritis and Ankylosing Spondylitis, Systemic Lupus Erythematosus (SLE), Systemic Sclerosis (SS), Sjogren Syndrome (SjS), Mixed connective tissue disease (MCTD), Inflammatory Myopathies (IM).
Fig. 3:
Fig. 3
Central figure.
See this image and copyright information in PMC

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