Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population

Introduction: Appropriate lipid-lowering therapies are essential for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to identify discrepancies between cholesterol management guidelines and current practice in an underserved population, with a focus on statin treatment. Methods: We reviewed the records of 1,042 consecutive patients seen between August 2018 and August 2019 in an outpatient academic primary care clinic. Eligibility for statin and other lipid-lowering therapies was determined based on the 2018 American Heart Association and American College of Cardiology (AHA/ACC) guideline on the management of blood cholesterol. Results: Among 464 statin-eligible patients, age was 61.1 +/- 10.4 years and 53.9% were female. Most patients were Black (47.2%), followed by Hispanic (45.7%), and White (5.0%). Overall, 82.1% of patients were prescribed a statin. Statin-eligible patients who qualified based only on a 10-year ASCVD risk > 7.5% were less likely to be prescribed a statin (32.8%, p 55 years (OR = 4.59 [95% CI 1.09 - 16.66], p = 0.026), hypertension (OR = 2.38 [95% CI 1.29 - 4.38], p = 0.005) and chronic kidney disease (OR = 3.95 [95% CI 1.42 - 14.30], p = 0.017). Factors independently associated with statin undertreatment were Black race (OR = 0.42 [95% CI 0.23 - 0.77], p = 0.005), and statin-eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 [95% CI 0.07 - 0.25], p < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to Black patients (86.8% vs 77.2%). Conclusion: Statin underprescription is seen in approximately one out of five eligible patients, and is independently associated with Black race, younger age, fewer comorbidities, and eligibility via 10-year ASCVD risk only. Hispanic patients are more likely to be on appropriate statin therapy compared to Black patients.