Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use: Insights from the patient and provider assessment of lipid management registry

Michael G. Nanna, Ann Marie Navar, Pearl Zakroysky, Qun Xiang, Anne C. Goldberg, Jennifer Robinson, Veronique Lee Roger, Salim S. Virani, Peter W.F. Wilson, Joseph Elassal, L. Veronica Lee, Tracy Y. Wang, Eric D. Peterson

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

IMPORTANCE African American individuals face higher atherosclerotic cardiovascular disease risk than white individuals; reasons for these differences, including potential differences in patient beliefs regarding preventive care, remain unknown. OBJECTIVE To evaluate differences in statin use between white and African American patients and identify the potential causes for any observed differences. DESIGN, SETTING, AND PARTICIPANTS Using the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data, we compared statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins. A total of 138 US community health care practices contributed to the data. Data analysis was conducted from March 2017 to May 2018. MAIN OUTCOMES AND MEASURES Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs. Poisson regression was used to evaluate the association between race and statin undertreatment, a category combining people who were not taking a statin or those taking a dose intensity lower than recommended. RESULTS A total of 5689 patients (806 [14.2%] African American) in the PALM registry were eligible for statin therapy. African American individuals were less likely than white individuals to be treated with a statin (570/807 [70.6%] vs 3654/4883 [74.8%]; P = .02). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 [33.3%] vs 2145 [43.9%], respectively; P < .001; relative risk, 1.07 [95% CI, 1.00-1.15]; P = .05, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 [76.0-121.0] mg/dL vs 85.0 [68.0-105.0] mg/dL; P < .001). African American individuals were less likely than white individuals to believe statins were safe (292 [36.2%] vs 2800 [57.3%]; P < .001) or effective (564 [70.0%] vs 3635 [74.4%]; P = .008) and were less likely to trust their clinician (663 [82.3%] vs 4579 [93.8%]; P < .001). Group differences in statin undertreatment were not significant after adjusting for demographic, clinical, and clinician factors, socioeconomic status, and patient beliefs (final adjusted relative risk, 1.03 [95% CI 0.96–1.11]; P = .35). CONCLUSIONS AND RELEVANCE African American individuals were less likely to receive guideline-recommended statin therapy. Demographic, clinical, socioeconomic, belief-related, and clinician differences contributed to observed differences and represent potential targets for intervention.

Original languageEnglish (US)
Pages (from-to)739-748
Number of pages10
JournalJAMA Cardiology
Volume3
Issue number8
DOIs
StatePublished - Aug 1 2018

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Registries
African Americans
Lipids
Pharmaceutical Preparations
Demography
Guidelines
Community Health Services
Preventive Medicine
Primary Prevention
Therapeutics
Secondary Prevention
Social Class
LDL Cholesterol
Outpatients
Cardiovascular Diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use : Insights from the patient and provider assessment of lipid management registry. / Nanna, Michael G.; Navar, Ann Marie; Zakroysky, Pearl; Xiang, Qun; Goldberg, Anne C.; Robinson, Jennifer; Roger, Veronique Lee; Virani, Salim S.; Wilson, Peter W.F.; Elassal, Joseph; Veronica Lee, L.; Wang, Tracy Y.; Peterson, Eric D.

In: JAMA Cardiology, Vol. 3, No. 8, 01.08.2018, p. 739-748.

Research output: Contribution to journalArticle

Nanna, MG, Navar, AM, Zakroysky, P, Xiang, Q, Goldberg, AC, Robinson, J, Roger, VL, Virani, SS, Wilson, PWF, Elassal, J, Veronica Lee, L, Wang, TY & Peterson, ED 2018, 'Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use: Insights from the patient and provider assessment of lipid management registry', JAMA Cardiology, vol. 3, no. 8, pp. 739-748. https://doi.org/10.1001/jamacardio.2018.1511
Nanna, Michael G. ; Navar, Ann Marie ; Zakroysky, Pearl ; Xiang, Qun ; Goldberg, Anne C. ; Robinson, Jennifer ; Roger, Veronique Lee ; Virani, Salim S. ; Wilson, Peter W.F. ; Elassal, Joseph ; Veronica Lee, L. ; Wang, Tracy Y. ; Peterson, Eric D. / Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use : Insights from the patient and provider assessment of lipid management registry. In: JAMA Cardiology. 2018 ; Vol. 3, No. 8. pp. 739-748.
@article{35f84c224ee241309c73ad358f69be04,
title = "Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use: Insights from the patient and provider assessment of lipid management registry",
abstract = "IMPORTANCE African American individuals face higher atherosclerotic cardiovascular disease risk than white individuals; reasons for these differences, including potential differences in patient beliefs regarding preventive care, remain unknown. OBJECTIVE To evaluate differences in statin use between white and African American patients and identify the potential causes for any observed differences. DESIGN, SETTING, AND PARTICIPANTS Using the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data, we compared statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins. A total of 138 US community health care practices contributed to the data. Data analysis was conducted from March 2017 to May 2018. MAIN OUTCOMES AND MEASURES Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs. Poisson regression was used to evaluate the association between race and statin undertreatment, a category combining people who were not taking a statin or those taking a dose intensity lower than recommended. RESULTS A total of 5689 patients (806 [14.2{\%}] African American) in the PALM registry were eligible for statin therapy. African American individuals were less likely than white individuals to be treated with a statin (570/807 [70.6{\%}] vs 3654/4883 [74.8{\%}]; P = .02). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 [33.3{\%}] vs 2145 [43.9{\%}], respectively; P < .001; relative risk, 1.07 [95{\%} CI, 1.00-1.15]; P = .05, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 [76.0-121.0] mg/dL vs 85.0 [68.0-105.0] mg/dL; P < .001). African American individuals were less likely than white individuals to believe statins were safe (292 [36.2{\%}] vs 2800 [57.3{\%}]; P < .001) or effective (564 [70.0{\%}] vs 3635 [74.4{\%}]; P = .008) and were less likely to trust their clinician (663 [82.3{\%}] vs 4579 [93.8{\%}]; P < .001). Group differences in statin undertreatment were not significant after adjusting for demographic, clinical, and clinician factors, socioeconomic status, and patient beliefs (final adjusted relative risk, 1.03 [95{\%} CI 0.96–1.11]; P = .35). CONCLUSIONS AND RELEVANCE African American individuals were less likely to receive guideline-recommended statin therapy. Demographic, clinical, socioeconomic, belief-related, and clinician differences contributed to observed differences and represent potential targets for intervention.",
author = "Nanna, {Michael G.} and Navar, {Ann Marie} and Pearl Zakroysky and Qun Xiang and Goldberg, {Anne C.} and Jennifer Robinson and Roger, {Veronique Lee} and Virani, {Salim S.} and Wilson, {Peter W.F.} and Joseph Elassal and {Veronica Lee}, L. and Wang, {Tracy Y.} and Peterson, {Eric D.}",
year = "2018",
month = "8",
day = "1",
doi = "10.1001/jamacardio.2018.1511",
language = "English (US)",
volume = "3",
pages = "739--748",
journal = "JAMA Cardiology",
issn = "2380-6583",
publisher = "American Medical Association",
number = "8",

}

TY - JOUR

T1 - Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use

T2 - Insights from the patient and provider assessment of lipid management registry

AU - Nanna, Michael G.

AU - Navar, Ann Marie

AU - Zakroysky, Pearl

AU - Xiang, Qun

AU - Goldberg, Anne C.

AU - Robinson, Jennifer

AU - Roger, Veronique Lee

AU - Virani, Salim S.

AU - Wilson, Peter W.F.

AU - Elassal, Joseph

AU - Veronica Lee, L.

AU - Wang, Tracy Y.

AU - Peterson, Eric D.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - IMPORTANCE African American individuals face higher atherosclerotic cardiovascular disease risk than white individuals; reasons for these differences, including potential differences in patient beliefs regarding preventive care, remain unknown. OBJECTIVE To evaluate differences in statin use between white and African American patients and identify the potential causes for any observed differences. DESIGN, SETTING, AND PARTICIPANTS Using the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data, we compared statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins. A total of 138 US community health care practices contributed to the data. Data analysis was conducted from March 2017 to May 2018. MAIN OUTCOMES AND MEASURES Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs. Poisson regression was used to evaluate the association between race and statin undertreatment, a category combining people who were not taking a statin or those taking a dose intensity lower than recommended. RESULTS A total of 5689 patients (806 [14.2%] African American) in the PALM registry were eligible for statin therapy. African American individuals were less likely than white individuals to be treated with a statin (570/807 [70.6%] vs 3654/4883 [74.8%]; P = .02). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 [33.3%] vs 2145 [43.9%], respectively; P < .001; relative risk, 1.07 [95% CI, 1.00-1.15]; P = .05, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 [76.0-121.0] mg/dL vs 85.0 [68.0-105.0] mg/dL; P < .001). African American individuals were less likely than white individuals to believe statins were safe (292 [36.2%] vs 2800 [57.3%]; P < .001) or effective (564 [70.0%] vs 3635 [74.4%]; P = .008) and were less likely to trust their clinician (663 [82.3%] vs 4579 [93.8%]; P < .001). Group differences in statin undertreatment were not significant after adjusting for demographic, clinical, and clinician factors, socioeconomic status, and patient beliefs (final adjusted relative risk, 1.03 [95% CI 0.96–1.11]; P = .35). CONCLUSIONS AND RELEVANCE African American individuals were less likely to receive guideline-recommended statin therapy. Demographic, clinical, socioeconomic, belief-related, and clinician differences contributed to observed differences and represent potential targets for intervention.

AB - IMPORTANCE African American individuals face higher atherosclerotic cardiovascular disease risk than white individuals; reasons for these differences, including potential differences in patient beliefs regarding preventive care, remain unknown. OBJECTIVE To evaluate differences in statin use between white and African American patients and identify the potential causes for any observed differences. DESIGN, SETTING, AND PARTICIPANTS Using the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data, we compared statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins. A total of 138 US community health care practices contributed to the data. Data analysis was conducted from March 2017 to May 2018. MAIN OUTCOMES AND MEASURES Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs. Poisson regression was used to evaluate the association between race and statin undertreatment, a category combining people who were not taking a statin or those taking a dose intensity lower than recommended. RESULTS A total of 5689 patients (806 [14.2%] African American) in the PALM registry were eligible for statin therapy. African American individuals were less likely than white individuals to be treated with a statin (570/807 [70.6%] vs 3654/4883 [74.8%]; P = .02). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 [33.3%] vs 2145 [43.9%], respectively; P < .001; relative risk, 1.07 [95% CI, 1.00-1.15]; P = .05, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 [76.0-121.0] mg/dL vs 85.0 [68.0-105.0] mg/dL; P < .001). African American individuals were less likely than white individuals to believe statins were safe (292 [36.2%] vs 2800 [57.3%]; P < .001) or effective (564 [70.0%] vs 3635 [74.4%]; P = .008) and were less likely to trust their clinician (663 [82.3%] vs 4579 [93.8%]; P < .001). Group differences in statin undertreatment were not significant after adjusting for demographic, clinical, and clinician factors, socioeconomic status, and patient beliefs (final adjusted relative risk, 1.03 [95% CI 0.96–1.11]; P = .35). CONCLUSIONS AND RELEVANCE African American individuals were less likely to receive guideline-recommended statin therapy. Demographic, clinical, socioeconomic, belief-related, and clinician differences contributed to observed differences and represent potential targets for intervention.

UR - http://www.scopus.com/inward/record.url?scp=85052103891&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052103891&partnerID=8YFLogxK

U2 - 10.1001/jamacardio.2018.1511

DO - 10.1001/jamacardio.2018.1511

M3 - Article

C2 - 29898219

AN - SCOPUS:85052103891

VL - 3

SP - 739

EP - 748

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

IS - 8

ER -