Suero-Abreu Giselle Alexandra, Karatasakis Aris, Rashid Sana, Tysarowski Maciej, Douglas Analise, Patel Richa, Siddiqui Emaad, Bhardwaj Aishwarya, Gerula Christine M, Matassa Daniel
Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA.
Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA 98195, USA.
Healthcare (Basel). 2020 Sep 24;8(4):361. doi: 10.3390/healthcare8040361.
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 with a focus on statin treatment in an underserved population based in a large single urban medical center. Among 1042 reviewed records, we identified 464 statin-eligible patients. Age was 61.0 ± 10.4 years and 53.9% were female. Most patients were black (47.2%), followed by Hispanic (45.7%) and white (5.0%). In total, 82.1% of patients were prescribed a statin. An appropriate statin was not prescribed in 32.4% of statin-eligible patients who qualified based only on a 10-year ASCVD risk of ≥7.5%. After adjustment for gender and health insurance status, appropriate statin treatment was independently associated with age >55 years (OR = 4.59 (95% CI 1.09-16.66), = 0.026), hypertension (OR = 2.38 (95% CI 1.29-4.38), = 0.005) and chronic kidney disease (OR = 3.95 (95% CI 1.42-14.30), = 0.017). Factors independently associated with statin undertreatment were black race (OR = 0.42 (95% CI 0.23-0.77), = 0.005) and statin-eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 (95% CI 0.07-0.25), < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to black patients (86.8% vs. 77.2%). 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.
降脂疗法对于动脉粥样硬化性心血管疾病（ASCVD）的一级和二级预防至关重要。本研究的目的是找出胆固醇管理指南与当前实践之间的差异，重点关注一家大型单一城市医疗中心服务不足人群中的他汀类药物治疗情况。在1042份审查记录中，我们确定了464名符合他汀类药物治疗条件的患者。年龄为61.0±10.4岁，53.9%为女性。大多数患者是黑人（47.2%），其次是西班牙裔（45.7%）和白人（5. .0%）。总共有82.1%的患者被处方了他汀类药物。在仅根据10年ASCVD风险≥7.5%符合条件的他汀类药物适用患者中，32.4%未被处方合适的他汀类药物。在调整性别和健康保险状况后，合适的他汀类药物治疗与年龄>55岁（OR = 4.59（95%CI 1.09 - 16.66），P = 0.026）、高血压（OR = 2.38（95%CI 1.29 - 4.38），P = 0.005）和慢性肾病（OR = 3.95（95%CI 1.42 - 14.30），P = 0.017）独立相关。与他汀类药物治疗不足独立相关的因素是黑人种族（OR = 0.42（95%CI 0.23 - 0.77），P = 0.005）和仅基于10年ASCVD风险升高的他汀类药物适用性（OR = 0.14（95%CI 0.07 - 0.25），P < 0.001）。与黑人患者相比，西班牙裔患者更有可能接受合适的他汀类药物治疗（86.8%对77.2%）。约五分之一的符合条件患者存在他汀类药物处方不足的情况，且与黑人种族、年龄较小、合并症较少以及仅通过10年ASCVD风险符合条件独立相关。与黑人患者相比，西班牙裔患者更有可能接受合适的他汀类药物治疗。
