Statins for secondary cardiovascular disease prevention for older primary care patients.

OBJECTIVES

To examine statin prescribing for secondary cardiovascular disease prevention at primary care visits by older patients in 2005-2006.

DESIGN

The National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey are cross-sectional, using a multistage random sample (112 primary sampling units, physicians and hospitals, patient visits). Characteristics from 4964 primary care visits were abstracted from medical records. Chi2 and logistic regression were performed to investigate associations with statin prescribing.

SETTING

US nonfederal physician offices and hospital outpatient departments.

PARTICIPANTS

Visits by patients aged 55 to 80 years with cerebrovascular, ischemic heart or peripheral vascular disease, aortic aneurysm, atherosclerosis, diabetes mellitus, or any 2 risk factors (hyperlipidemia, hypertension, or smoking).

MEASUREMENTS

The dependent variable was statin prescribing. Independent variables were age, sex, ethnicity, primary payment source, number of comorbidities, metropolitan statistical area, geographic region, and clinical setting.

RESULTS

Statins were prescribed at 37.7% of visits. Logistic regression negative predictors for statin prescribing included non-Hispanic black ethnicity and Medicaid coverage. Number of comorbidities was a positive predictor.

CONCLUSION

Statins are prescribed at much fewer visits by higher-risk older patients, especially non-Hispanic black patients and Medicaid beneficiaries, than would be expected from their comorbidities.