Department of Medicine, Forrest General Hospital, Hattiesburg, MS.
Division of Cardiology, Lahey Hospital, and Medical Center, Beth Israel Lahey Health, Burlington, MA.
Am Heart J. 2022 Oct;252:60-69. doi: 10.1016/j.ahj.2022.05.015. Epub 2022 May 27.
Statins are a cornerstone guideline-directed medical therapy for secondary prevention of ischemic heart disease (IHD). However, recent temporal trends and disparities in statin utilization for IHD have not been well characterized.
This retrospective analysis included data from outpatient adult visits with IHD from the National Ambulatory Medical Care Survey (NAMCS) between January 2006 and December 2018. We examined the trends and predictors of statin utilization in outpatient adult visits with IHD.
Between 2006 and 2018, we identified a total of 542,704,112 weighted adult ambulatory visits with IHD and of those 46.6% were using or prescribed statin. Middle age (50-74 years) (adjusted odds ratio [aOR] 1.65, 95% confidence interval [CI] 1.28-2.13 P < .001) and old age (≥75 years) (aOR = 1.66, CI 1.26-2.19, P < .001) compared to young age (18-49 years), and male sex (aOR = 1.35, CI 1.23-1.48, P < .001) were associated with greater likelihood of statin utilization, whereas visits with non-Hispanic (NH) Black patients (aOR = 0.75, CI 0.61-0.91, P = .005) and Hispanic patients (aOR = 0.74, CI 0.60-0.92, P = .006) were associated with decreased likelihood of statin utilization compared to NH White patient visits. Compared with private insurance, statin utilization was nominally lower in Medicare (aOR = 0.91, CI 0.80-1.02, P = .112), Medicaid (aOR = 0.78, CI 0.59-1.02, P = .072) and self-pay/no charge (aOR = 0.72, CI 0.48-1.09, P = .122) visits, however did not reach statistical significance. There was no significant uptake in statin utilization from 2006 (44.1%) to 2018 (46.2%) (P = .549).
Substantial gaps remain in statin utilization for patients with IHD, with no significant improvement in use between 2006 and 2018. Persistent disparities in statin prescription remain, with the largest treatment gaps among younger patients, women, and racial/ethnic minorities (NH Blacks and Hispanics).
他汀类药物是缺血性心脏病（IHD）二级预防的指导方针导向的医学治疗的基石。然而，他汀类药物在 IHD 中的利用的最新时间趋势和差异尚未得到很好的描述。
本回顾性分析包括 2006 年 1 月至 2018 年 12 月期间国家门诊医疗保健调查（NAMCS）中 IHD 的门诊成年就诊数据。我们研究了 IHD 门诊成年就诊中他汀类药物利用的趋势和预测因素。
在 2006 年至 2018 年间，我们共确定了 542704112 次 IHD 门诊成人就诊，其中 46.6%的患者正在使用或开处方他汀类药物。中老年人（50-74 岁）（调整后的优势比[aOR]1.65，95%置信区间[CI]1.28-2.13，P <.001）和老年人（≥75 岁）（aOR=1.66，CI 1.26-2.19，P <.001）与年轻（18-49 岁）相比，更有可能使用他汀类药物，而男性（aOR=1.35，CI 1.23-1.48，P <.001）与女性相比，更有可能使用他汀类药物，而非西班牙裔（NH）黑人患者（aOR=0.75，CI 0.61-0.91，P=0.005）和西班牙裔患者（aOR=0.74，CI 0.60-0.92，P=0.006）与 NH 白人患者就诊相比，他汀类药物的使用可能性降低。与私人保险相比，医疗保险（aOR=0.91，CI 0.80-1.02，P=0.112）、医疗补助（aOR=0.78，CI 0.59-1.02，P=0.072）和自付/无收费（aOR=0.72，CI 0.48-1.09，P=0.122）就诊的他汀类药物使用率略低，但没有统计学意义。从 2006 年（44.1%）到 2018 年（46.2%），他汀类药物的使用率并没有显著提高（P=0.549）。
IHD 患者的他汀类药物使用率仍存在很大差距，2006 年至 2018 年期间使用率没有明显改善。他汀类药物处方仍然存在差异，年轻患者、女性和少数族裔（NH 黑人和西班牙裔）的治疗差距最大。
