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Gaps and Disparities in Primary Prevention Statin Prescription During Outpatient Care

      The 2018 American College of Cardiology/American Heart Association Guideline on the Management of Blood Cholesterol recommends statin therapy for eligible patients to reduce the risk of atherosclerotic cardiovascular disease (ASCVD). We extracted electronic health record data for patients with at least one primary care or cardiology visit between October 2018 and January 2020 at an urban, academic medical center in New York City. Clinical and demographic data were used to identify patients eligible for primary prevention statin therapy. Statin prescription status was extracted from the electronic health record, and multivariate logistic regression was used to assess the association between statin prescription and age, gender, race, ethnicity, and other clinical and demographic covariables. In 7,550 patients eligible for primary prevention statin therapy, 3,994 (52.9%) were prescribed statins on at least 1 visit. Statin prescription was highest in patients with diabetes mellitus (73.6%) and with a 10-year ASCVD risk ≥20% (60.6%) and was lowest for those with a 10-year ASCVD risk between 5% and 7.5% (18.7%). Compared with those never prescribed statins, patients prescribed statins were less likely to be women, mainly driven by lower statin prescription rates for women with diabetes. In a fully adjusted model, women remained less likely to be prescribed statin therapy (adjusted odds ratios 0.79, 95% confidence interval 0.71 to 0.88). In conclusion, primary prevention statin therapy remains underutilized.
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      References

        • Virani SS
        • Alonso A
        • Aparicio HJ
        • Benjamin EJ
        • Bittencourt MS
        • Callaway CW
        • Carson AP
        • Chamberlain AM
        • Cheng S
        • Delling FN
        • Elkind MSV
        • Evenson KR
        • Ferguson JF
        • Gupta DK
        • Khan SS
        • Kissela BM
        • Knutson KL
        • Lee CD
        • Lewis TT
        • Liu J
        • Loop MS
        • Lutsey PL
        • Ma J
        • Mackey J
        • Martin SS
        • Matchar DB
        • Mussolino ME
        • Navaneethan SD
        • Perak AM
        • Roth GA
        • Samad Z
        • Satou GM
        • Schroeder EB
        • Shah SH
        • Shay CM
        • Stokes A
        • VanWagner LB
        • Wang NY
        • Tsao CW
        • American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee
        Heart disease and stroke Statistics-2021 update: a report from the American Heart Association.
        Circulation. 2021; 143: e254-e743
        • Dixon DL
        • Sharma G
        • Sandesara PB
        • Yang E
        • Braun LT
        • Mensah GA
        • Sperling LS
        • Deedwania PC
        • Virani SS
        Therapeutic inertia in cardiovascular disease prevention: time to move the bar.
        J Am Coll Cardiol. 2019; 74: 1728-1731
        • Taylor F
        • Huffman MD
        • Macedo AF
        • Moore TH
        • Burke M
        • Davey Smith GD
        • Ward K
        • Ebrahim S
        Statins for the primary prevention of cardiovascular disease.
        Cochrane Database Syst Rev. 2013; 2013CD004816
        • Grundy SM
        • Stone NJ
        • Bailey AL
        • Beam C
        • Birtcher KK
        • Blumenthal RS
        • Braun LT
        • de Ferranti S
        • Faiella-Tommasino J
        • Forman DE
        • Goldberg R
        • Heidenreich PA
        • Hlatky MA
        • Jones DW
        • Llyod-Jones D
        • Lopez-Pajares N
        • Ndumele CE
        • Orringer CE
        • Peralta CA
        • Ssaseen JJ
        • Smith Jr, SC
        • Sperling L
        • Virani SS
        • Yeboah J
        2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.
        Circulation. 2019; 139: e1082-e1143
        • Patel N
        • Bhargava A
        • Kalra R
        • Parcha V
        • Arora G
        • Muntner P
        • Arora P.
        Trends in lipid, lipoproteins, and statin use Among U.S. Adults.
        J Am Coll Cardiol. 2019; 74: 2525-2528
        • Salami JA
        • Warraich H
        • Valero-Elizondo J
        • Spatz ES
        • Desai NR
        • Rana JS
        • Virani SS
        • Blankstein R
        • Khera A
        • Blaha MJ
        • Blumenthal RS
        • Lloyd-Jones D
        • Nasir K
        National trends in statin use and expenditures in the US adult population From 2002 to 2013: insights From the medical expenditure panel survey.
        JAMA Cardiol. 2017; 2: 56-65
        • Suero-Abreu GA
        • Karatasakis A
        • Rashid S
        • Tysarowski M
        • Douglas A
        • Patel R
        • Siddiqui E
        • Bhardwaj A
        • Gerula CM
        • Matassa D.
        Factors associated with disparities in appropriate statin therapy in an outpatient inner city population.
        Healthcare (Basel). 2020; 8: 361
        • Young L
        • Cho L.
        Unique cardiovascular risk factors in women.
        Heart. 2019; 105: 1656-1660
        • Nanna MG
        • Wang TY
        • Xiang Q
        • Goldberg AC
        • Robinson JG
        • Roger VL
        • Virani SS
        • Wilson PWF
        • Louie MJ
        • Koren A
        • Li Z
        • Peterson ED
        • Navar AM.
        Sex differences in the use of statins in community practice.
        Circ Cardiovasc Qual Outcomes. 2019; 12e005562
        • Gamboa CM
        • Colantonio LD
        • Brown TM
        • Carson AP
        • Safford MM.
        Race-sex differences in statin use and low-density lipoprotein cholesterol control Among people With diabetes mellitus in the reasons for geographic and racial differences in stroke study.
        J Am Heart Assoc. 2017; 6e004264
        • Segars LW
        • Lea AR.
        Assessing prescriptions for statins in ambulatory diabetic patients in the United States: a national, cross-sectional study.
        Clin Ther. 2008; 30: 2159-2166
        • Bradley CK
        • Wang TY
        • Li S
        • Robinson JG
        • Roger VL
        • Goldberg AC
        • Virani SS
        • Louie MJ
        • Lee LV
        • Peterson ED
        • Navar AM.
        Patient-reported reasons for declining or discontinuing statin therapy: insights from the PALM registry.
        J Am Heart Assoc. 2019; 8e011765
        • Mann D
        • Reynolds K
        • Smith D
        • Muntner P.
        Trends in statin use and low-density lipoprotein cholesterol levels Among US adults: impact of the 2001 National Cholesterol Education Program guidelines.
        Ann Pharmacother. 2008; 42: 1208-1215
        • Montori VM
        • Brito JP
        • Ting HH.
        Patient-centered and practical application of new high cholesterol guidelines to prevent cardiovascular disease.
        JAMA. 2014; 311: 465-466
        • DeFilippis EM
        • Collins BL
        • Singh A
        • Biery DW
        • Fatima A
        • Qamar A
        • Berman AN
        • Gupta A
        • Cawley M
        • Wood MJ
        • Klein J
        • Hainer J
        • Gulati M
        • Taqueti VR
        • Di Carli MF
        • Nasir K
        • Bhatt DL
        • Blankstein R.
        Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham Young-Mi registry.
        Eur Heart J. 2020; 41: 4127-4137
        • Mehta LS
        • Beckie TM
        • DeVon HA
        • Grines CL
        • Krumholz HM
        • Johnson MN
        • Lindley KJ
        • Vaccarino V
        • Wang TY
        • Watson KE
        • Wenger NK
        • American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research
        Acute myocardial infarction in women: a scientific statement from the American Heart Association.
        Circulation. 2016; 133: 916-947
        • Gu A
        • Kamat S
        • Argulian E.
        Trends and disparities in statin use and low-density lipoprotein cholesterol levels among US patients with diabetes, 1999–2014.
        Diabetes Res Clin Pract. 2018; 139: 1-10
        • Safford M
        • Eaton L
        • Hawley G
        • Brimacombe M
        • Rajan M
        • Li H
        • Pogach L.
        Disparities in use of lipid-lowering medications among people with type 2 diabetes mellitus.
        Arch Intern Med. 2003; 163: 922-928
        • Ye S
        • Leppin AL
        • Chan AY
        • Chang N
        • Moise N
        • Poghosyan L
        • Montori VM
        • Kronish I
        An informatics approach to implement support for shared decision making for primary prevention statin therapy.
        MDM Policy Pract. 2018; 32381468318777752
        • Weymiller AJ
        • Montori VM
        • Jones LA
        • Gafni A
        • Guyatt GH
        • Bryant SC
        • Christianson TJ
        • Mullan RJ
        • Smith SA.
        Helping patients with type 2 diabetes mellitus make treatment decisions: statin choice randomized trial.
        Arch Intern Med. 2007; 167: 1076-1082
        • Adusumalli S
        • Westover JE
        • Jacoby DS
        • Small DS
        • VanZandbergen C
        • Chen J
        • Cavella AM
        • Pepe R
        • Rareshide CAL
        • Snider CK
        • Volpp KG
        • Asch DA
        • Patel MS.
        Effect of passive choice and active choice interventions in the electronic health record to cardiologists on statin prescribing: a cluster randomized clinical trial.
        JAMA Cardiol. 2021; 6: 40-48
        • Scirica BM
        • Cannon CP
        • Fisher NDL
        • Gaziano TA
        • Zelle D
        • Chaney K
        • Miller A
        • Nichols H
        • Matta L
        • Gordon WJ
        • Murphy S
        • Wagholikar KB
        • Plutzky J
        • MacRae CA.
        Digital care transformation: interim report From the first 5000 patients enrolled in a remote algorithm-based cardiovascular risk management program to improve lipid and hypertension control.
        Circulation. 2021; 143: 507-509
      1. 2020. Medicare FEE-FOR-service supplemental improper payment data. In: Services. u.S. 2020ed. Department of Health & Human Services, Center.

        • Wood FA
        • Howard JP
        • Finegold JA
        • Nowbar AN
        • Thompson DM
        • Arnold AD
        • Rajkumar CA
        • Connolly S
        • Cegla J
        • Stride C
        • Sever P
        • Norton C
        • Thom SAM
        • Shun-Shin MJ
        • Francis DP.
        N-of-1 trial of a statin, placebo, or no treatment to assess side effects.
        N Engl J Med. 2020; 383: 2182-2184
        • Herrett E
        • Williamson E
        • Brack K
        • Beaumont D
        • Perkins A
        • Thayne A
        • Shakur-Still H
        • Roberts I
        • Prowse D
        • Goldacre B
        • van Staa T
        • MacDonald TM
        • Armitage J
        • Wimborne J
        • Melrose P
        • Singh J
        • Brooks L
        • Moore M
        • Hoffman M
        • Smeeth L
        • StatinWISE Trial Group
        Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials.
        BMJ. 2021; 372: n135
        • Flores Rosario K
        • Mehta A
        • Ayers C
        • Engel Gonzalez P
        • Pandey A
        • Khera R
        • Kaplan R
        • Blaha MJ
        • Khera A
        • Blumenthal RS
        • Nasir K
        • Rodriguez CJ
        • Joshi PH
        Performance of the pooled cohort equations in Hispanic individuals Across the United States: insights From the multi-ethnic study of atherosclerosis and the Dallas Heart study.
        J Am Heart Assoc. 2021; 10e018410