• Posted July 26, 2023

Minorities, Women Are Shortchanged When It Comes to Statins

In yet another example of inequities in U.S. health care, new research indicates that many women and minority men who need statins to protect their heart aren't getting them.

“The recommendation to use statins to treat and prevent atherosclerotic cardiovascular disease has been supported by guidelines from major clinical societies for decades,” said study author Dr. Ravy Vajravelu, an assistant professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition at the University of Pittsburgh School of Medicine.

Yet Vajravelu and his associates found that Black men and Hispanic women with high cholesterol are about 25% less likely than white men to get and take meds like Lipitor (atorvastatin) and Zocor (simvastatin) when they need them for prevention of heart disease.

Those disparities concern statin use among patients at risk for future heart disease. Vajravelu and his colleagues found similarly large racial gaps among patients who need statins to control existing heart disease.

Among people who already have heart disease, the study found Black men, mixed race men, Mexican women, Hispanic women, white women, and Black women used statins less often than white men.

Compared with their white male peers, Black men with existing heart disease were 19% less likely to be taking statins, while Mexican American women were 64% less likely to be using the drugs. For white women, the odds were 31% lower, according to the study.

Statin pills help prevent clogged arteries (atherosclerosis) in people with high cholesterol levels. Left unchecked, fatty buildup in the arteries can raise the risk for heart attack and stroke.

For the study, researchers sifted through cholesterol, heart health and statin use data collected between 2015 and 2020 (pre-pandemic) by the U.S. National Health and Nutrition Examination Survey (NHANES).

NHANES information was then stacked up against cholesterol guidelines established by the American College of Cardiology and the American Heart Association in 2013 and 2018.

The result: even after taking into account income, health insurance status and access to routine medical care, the study team concluded that while the degree of the gap varies, Black and Hispanic men and women as a whole are significantly less likely to get the statins they need than white men.

So what's going on?

Vajravelu cautioned that “in this type of research, it is not possible to definitively pinpoint the cause of the unexplained disparities.”

It could be that some patients were prescribed the medication but did not take it, perhaps due to a lack of trust in the medical care offered, he said.

However, Vajravelu said his team's analysis "indicates that bias, stereotyping and mistrust may contribute to the disparity,” whether those tendencies on the part of medical caregivers are conscious or not.

“For example, many providers," said Vajravelu, "including me, were trained to recognize prototypical signs and risk factors of medical conditions based on the example of non-Hispanic white men. We as providers need to retrain ourselves to realize that other groups can also have high levels of risk, so that we provide objective treatment without the influence of 'gut feelings.'"

The bottom line is that the uneven way in which patients are accessing statins reflects the fact that “there are disparities in health care delivery in the United States," Vajravelu noted.

“Many eligible individuals who could benefit from statin therapy are not currently treated,” agreed Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles and co-chief of the UCLA Division of Cardiology.

That's important because “improved use of statin therapy could prevent hundreds of thousands of fatal and non-fatal cardiovascular events each year in the U.S.," said Fonarow, who was not part of the study team.

“From a public health and health equity standpoint, these gaps and disparities in the use of statin therapy are alarming,” he added. “Increased efforts for implementation of statin therapy to achieve equitable and optimal use should be a priority.”

The findings appear in the July 25 issue of the Annals of Internal Medicine.

More information

The U.S. Preventive Services Task Force has more on statin use recommendations.

SOURCES: Ravy K. Vajravelu, MD, MSCE, assistant professor, medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine; Gregg C. Fonarow, MD, director, Ahmanson-UCLA Cardiomyopathy Center, and co-director, UCLA Preventative Cardiology Program, and co-chief, UCLA Division of Cardiology, Los Angeles; Annals of Internal Medicine, July 25, 2023