scholarly journals Educational inequalities in statin treatment for preventing cardiovascular disease: cross-sectional analysis of UK Biobank

2020 ◽  
Author(s):  
Alice R Carter ◽  
Dipender Gill ◽  
Richard Morris ◽  
George Davey Smith ◽  
Amy E Taylor ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Educational Attainment ◽  
Prescription Data ◽  
List Type ◽  
Uk Biobank ◽  
Cross Sectional ◽  
Statin Use ◽  
Years Of Schooling

AbstractImportanceThe most socioeconomically deprived individuals remain at the greatest risk of cardiovascular disease. Differences in risk adjusted use of statins between educational groups may contribute to these inequalities.ObjectiveTo identify whether people with lower levels of educational attainment are less likely to take statins for a given level of cardiovascular risk.DesignCross-sectional analysis of a population-based cohort study and linked longitudinal primary care records.SettingUK Biobank data from baseline assessment centres, linked primary care data and hospital episode statisticsParticipantsUK Biobank participants (N = 489 679, mean age = 56, 54% female) with complete data on educational attainment and self-reported medication use. Secondary analyses were carried out on a subsample of participants with linked primary care data (N = 217 675).Main outcome measuresStatin use self-reported to clinic nurses at baseline assessment centres, validated with linked prescription data in a subsample of participants in secondary analyses.ResultsGreater education was associated with lower statin use, whilst higher cardiovascular risk (assessed by QRISK3 score) was associated with higher statin use in both females and males. There was evidence of an interaction between QRISK3 and education, such that for the same QRISK3 score, people with more education were more likely to report taking statins. For example, in women with 7 years of schooling, equivalent to leaving school with no formal qualifications, a one unit increase in QRISK3 score was associated with a 6% higher odds of statin use (odds ratio (OR) 1.06, 95% CI 1.05, 1.06). In contrast, in women with 20 years of schooling, equivalent to obtaining a degree, a one unit increase in QRISK3 score was associated with an 11% higher odds of statin use (OR 1.11, 95% CI 1.10, 1.11). Comparable ORs in men were 1.04 (95% CI 1.04, 1.05) for men with 7 years of schooling and (95% CI 1.07, 1.07) for men with 20 years of schooling.ConclusionsFor the same level of cardiovascular risk, individuals with lower educational attainment are less likely to receive statins, likely contributing to health inequalities.SummaryWhat is already known on this topic?Despite reductions in the rates of cardiovascular disease in high income countries, individuals who are the most socioeconomically deprived remain at the highest risk.Although intermediate lifestyle and behavioural risk factors explain some of this, much of the effect remains unexplained.What does this study add?For the same increase in QRISK3 score, the likelihood of statin use increased more in individuals with high educational attainment compared with individuals with lower educational attainment.These results were similar when using UK Biobank to derive QRISK3 scores and when using QRISK scores recorded in primary care records, and when using self-reported statin prescription data or prescription data from linked primary care records.The mechanisms leading to these differences are unknown, but both health seeking behaviours and clinical factors may contribute.

scholarly journals Cross-sectional analysis of educational inequalities in primary prevention statin use in UK Biobank

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319238
Author(s):  
Alice Rose Carter ◽  
Dipender Gill ◽  
George Davey Smith ◽  
Amy E Taylor ◽  
Neil M Davies ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Educational Attainment ◽  
Cardiovascular Prevention ◽  
Uk Biobank ◽  
Cross Sectional ◽  
Unit Increase ◽  
Using Data ◽  
Large Prospective Cohort Study ◽  
Statin Use ◽  
Years Of Schooling

ObjectiveIdentify whether participants with lower education are less likely to report taking statins for primary cardiovascular prevention than those with higher education, but an equivalent increase in underlying cardiovascular risk.MethodsUsing data from a large prospective cohort study, UK Biobank, we calculated a QRISK3 cardiovascular risk score for 472 097 eligible participants with complete data on self-reported educational attainment and statin use (55% female participants; mean age 56 years). We used logistic regression to explore the association between (i) QRISK3 score and (ii) educational attainment on self-reported statin use. We then stratified the association between QRISK3 score and statin use, by educational attainment to test for interactions.ResultsThere was evidence of an interaction between QRISK3 score and educational attainment. Per unit increase in QRISK3 score, more educated individuals were more likely to report taking statins. In women with ≤7 years of schooling, a one unit increase in QRISK3 score was associated with a 7% higher odds of statin use (OR 1.07, 95% CI 1.07 to 1.07). In women with ≥20 years of schooling, a one unit increase in QRISK3 score was associated with an 14% higher odds of statin use (OR 1.14, 95% CI 1.14 to 1.15). Comparable ORs in men were 1.04 (95% CI 1.04 to 1.05) for ≤7 years of schooling and 1.08 (95% CI 1.08, 1.08) for ≥20 years of schooling.ConclusionPer unit increase in QRISK3 score, individuals with lower educational attainment were less likely to report using statins, likely contributing to health inequalities.

scholarly journals 145Educational inequalities in primary prevention statin use in UK Biobank

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Alice Carter ◽  
Dipender Gill ◽  
Richard Morris ◽  
George Davey Smith ◽  
Amy Taylor ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Educational Attainment ◽  
Self Report ◽  
Risk Scores ◽  
Uk Biobank ◽  
Preventive Medication ◽  
Unit Increase ◽  
Statin Use ◽  
Years Of Schooling

Abstract Background Socioeconomic inequalities in cardiovascular disease are well documented, but the association of socioeconomic position with treatment for cardiovascular disease prevention is unclear. Methods Using data from a large prospective cohort study, UK Biobank, we calculated QRISK3 cardiovascular risk scores for 472 097 eligible participants with complete data on self-reported educational attainment and statin use (55% female; mean age, 56). We used logistic regression to explore the association between i) QRISK3 score and ii) educational attainment on self-report statin use. We then stratified the association between QRISK3 score, and statin use by educational attainment to test for interactions. Results For an equivalent QRISK3 score, more educated individuals were more likely to report taking statins. In women with 7 years of schooling, a one unit increase in QRISK3 score was associated with a 7% higher odds of statin use (odds ratio (OR) 1.07, 95% CI 1.07, 1.07). In women with 20 years of schooling, a one unit increase in QRISK3 score was associated with an 14% higher odds of statin use (OR 1.14, 95% CI 1.14, 1.15). Comparable ORs in men were 1.04 (95% CI 1.04, 1.05) for 7 years of schooling and 1.08 (95% CI 1.08, 1.08) for 20 years of schooling. Conclusions Individuals with less education are less likely to access statins conditional on cardiovascular risk factors. Key messages Inequalities in access to cardiovascular preventive medication are likely contributing to cardiovascular inequalities.

scholarly journals Trends in the Degree of Control and Treatment of Cardiovascular Risk Factors in People With Type 2 Diabetes in a Primary Care Setting in Catalonia During 2007–2018

2022 ◽  
Vol 12 ◽  
Author(s):  
Manel Mata-Cases ◽  
Bogdan Vlacho ◽  
Jordi Real ◽  
Ramon Puig-Treserra ◽  
Magdalena Bundó ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Beta Blockers ◽  
Density Lipoprotein ◽  
Cross Sectional ◽  
Lipid Control

ObjectiveTo assess the trends in cardiovascular risk factor control and drug therapy from 2007 to 2018 in subjects with type 2 diabetes mellitus (T2DM).Materials and MethodsCross-sectional analysis using yearly clinical data and treatment obtained from the SIDIAP database. Patients aged ≥18 years with a diagnosis of T2DM seen in primary care in Catalonia, Spain. ResultsThe number of T2DM patients increased from 299,855 in 2007 to 394,266 in 2018. We also found an increasing prevalence of cardiovascular disease, heart failure, and chronic kidney disease (from 18.4 to 24.4%, from 4.5 to 7.3%, and from 20.2 to 31.3%, respectively). The achievement of glycemic targets (HbA1c<7%) scarcely changed (54.9% to 55.9%). Major improvements were seen in blood pressure (≤140/90 mmHg: from 55% to 71.8%), and in lipid control (low-density lipoprotein cholesterol <100 mg/dl: 33.4% to 48.4%), especially in people with established cardiovascular disease (48.8 to 69.7%). Simultaneous achievement of all three targets improved from 12.5% to 20.1% in the overall population and from 24.5% to 32.2% in those with cardiovascular disease but plateaued after 2013. There was an increase in the percentage of patients treated with any antidiabetic drug (70.1% to 81.0%), especially metformin (47.7% to 67.7%), and DPP4i (0 to 22.6%). The use of SGLT-2 and GLP-1ra increased over the years, but remained very low in 2018 (5.5% and 2.1% of subjects, respectively). There were also relevant increases in the use of statins (38.0% to 49.2%), renin-angiotensin system (RAS) drugs (52.5% to 57.2%), and beta-blockers (14.3% to 22.7%).ConclusionsDuring the 2007-2018 period, relevant improvements in blood pressure and lipid control occurred, especially in people with cardiovascular disease. Despite the increase in the use of antidiabetic and cardiovascular drugs, the proportion of patients in which the three objectives were simultaneously achieved is still insufficient and plateaued after 2013. The use of antidiabetic drugs with demonstrated cardio renal benefits (SGLT-2 and GLP-1ra) increased over the years, but their use remained quite low.

scholarly journals Appropriateness of aspirin prescribing for primary and secondary prevention of cardiovascular disease in type 2 diabetes in different care settings

2021 ◽  
Author(s):  
Shi Ying Tan ◽  
Heather Cronin ◽  
Stephen Byrne ◽  
Adrian O’Donovan ◽  
Antoinette Tuthill
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Shared Care ◽  
University Hospital ◽  
Cross Sectional ◽  
Prevention Of Cardiovascular Disease

Abstract Background Type 2 diabetes is associated with an increased cardiovascular risk. Use of aspirin has been shown to be of benefit for secondary prevention of cardiovascular disease in patients with type 2 diabetes; benefits in primary prevention have not been clearly proven. Aims This study aims to (a) determine if aspirin is prescribed appropriately in type 2 diabetes for primary or secondary prevention of cardiovascular disease (CVD) and (b) evaluate whether there are differences in aspirin prescribing according to where people receive their care. Design Cross-sectional study Methods The medical records of individuals with type 2 diabetes aged over 18 years and attending Elmwood Primary Care Centre and Cork University Hospital Diabetes outpatient clinics (n = 400) between February and August 2017 were reviewed. Results There were 90 individuals exclusively attending primary care and 310 persons attending shared care. Overall, 49.0% (n = 196) of those were prescribed aspirin, of whom 42.3% were using it for secondary prevention. Aspirin was used significantly more in people attending shared care (p < 0.001). About 10.8% of individuals with diabetes and CVD attending shared care met guidelines for, but were not prescribed aspirin. Conclusion A significant number of people with type 2 diabetes who should have been prescribed aspirin for secondary prevention were not receiving it at the time of study assessment. In contrast, a substantial proportion who did not meet criteria for aspirin use was prescribed it for primary prevention.

scholarly journals Evaluation of LDL goal achievement in statin consumption, south east of Iran

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Malihe Aghasizadeh ◽  
Saeede Khosravi Bizhaem ◽  
Mahin Baniasadi ◽  
Mohammad Reza Khazdair ◽  
Toba Kazemi
Keyword(s):  
Cardiovascular Risk ◽  
Statin Therapy ◽  
Goal Achievement ◽  
Moderate Intensity ◽  
Cvd Risk ◽  
Intensity Pattern ◽  
Cross Sectional ◽  
Low Intensity ◽  
Very High ◽  
Statin Use

AbstractLipid goal achievement and statin consumption were estimated at extreme/very-high/high/moderate and low cardiovascular risk categories. In the cross-sectional study, 585 patients treated with statin therapy referring to the heart clinic of Birjand were recruited. Patients were classified and examined LDL-C values and the proportion reaching targets according to the American Association of Clinical Endocrinologists guideline. Three patterns of statin use (high/moderate/low-intensity statin therapy) in all patients were examined and attainments of LDL-C goal in cardiovascular risk groups have been demonstrated. Over half the populations (57.6%) were in the very-high CVD risk group. The results showed that the proportion of patients meeting total LDL-C goal values according to the guidelines was 43.4%. The frequency of patient had achievement LDL goal lower in high-intensity pattern (N = 13, 2.3%), compared with moderate (N = 496, 86.1%) and low-intensity patterns (N = 67, 11.6%). In general, LDL-C goal achievement was greatest with moderate-intensity statin use. LDL-C reduction after statin consumption was estimated about one-third of the studied population. It seems likely that the achievement of a therapeutic target for serum lipids such as LDL-C improved is far more cost-effective and would be able to reach the target LDL as well changing the type and intensity of statins.

scholarly journals Blood pressure and cholesterol measurements in primary care: cross-sectional analyses in a dynamic cohort

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0131
Author(s):  
Annemarijn de Boer ◽  
Monika Hollander ◽  
Ineke van Dis ◽  
Frank L.J. Visseren ◽  
Michiel L Bots ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Mixed Model ◽  
Time Window ◽  
Guideline Implementation ◽  
Cross Sectional ◽  
Menopausal Women ◽  
History Of ◽  
Post Menopausal

BackgroundGuidelines on cardiovascular risk management (CVRM) recommend blood pressure (BP) and cholesterol measurements every five years in men ≥40 and (post-menopausal) women ≥50 years.AimEvaluate CVRM guideline implementation.Design & settingCross-sectional analyses in a dynamic cohort using primary care electronic health record (EHR) data from the Julius General Practitioners’ Network (n=388,929).MethodWe assessed trends (2008–2018) in the proportion of patients with at least one measurement (BP and cholesterol) every one, two, and five years, in those with a history of (1) cardiovascular disease (CVD) and diabetes, (2) diabetes only, (3) CVD only, (4) cardiovascular risk assessment (CRA) indication based on other medical history, or (5) no CRA indication. We evaluated trends over time using logistic regression mixed model analyses.ResultsTrends in annual BP and cholesterol measurement increased for patients with a history of CVD from 37.0% to 48.4% (P<0.001) and 25.8% to 40.2% (P<0.001). In the five-year window 2014–2018, BP and cholesterol measurements were performed in respectively 78.5% and 74.1% of all men ≥40 years and 82.2% and 78.5% in all women ≥50 years. Least measured were patients without a CRA indication: men 60.2% and 62.4%; women 55.5% and 59.3%.ConclusionThe fairly high frequency of CVRM measurements available in the EHR of patients in primary care suggests an adequate implementation of the CVRM guideline. As nearly all individuals visit the general practitioner once within a five-year time window, improvement of CVRM remains very well possible, especially in those without a CRA indication.

Abstract P160: Is Higher Educational Attainment or Higher Income Protective for Cardiovascular Risk in Deaf American Sign Language (ASL) Users?

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Michael M McKee ◽  
Kimberly C McKee ◽  
Erika Sutter ◽  
Thomas Pearson
Keyword(s):  
High School ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
General Population ◽  
Educational Attainment ◽  
Sign Language ◽  
Household Income ◽  
Annual Household Income ◽  
Low Education ◽  
Higher Educational Attainment

Background: Deaf ASL users appear to be burdened with higher cardiovascular risk due to communication barriers in the health care setting and from lack of accessible health educational and outreach programs. It is well known among the general population that higher educational attainment and income are highly correlated and provide cardiovascular protection. It is unknown if the same effect is seen among Deaf ASL users. Objective We sought to examine whether educational attainment and/or annual household income are inversely associated with cardiovascular risk in a sample of Deaf ASL users. Methods: The Deaf Health Survey (DHS) is an adapted and translated Behavioral Risk Factor Surveillance System (BRFSS) into sign language. A sample of 339 Deaf adults from the Rochester, New York MSA participated in the 2008 DHS and is included in the analysis. We assessed education (≤high school [low education], some college, and 4 year college degree or higher [referent]) and annual household income (<$25,000 versus ≥$25,000 [referent]). We constructed an aggregate (i.e. self-report of any of the four cardiovascular disease (CVD) equivalents: diabetes, myocardial infarction (MI), cerebral vascular attack (CVA), and angina) and conducted χ² tests of association for education and income. After excluding for any missing data on key variables, we conducted multi-logistic regression adjusting for : age, sex, race/ethnicity, and smoking. Results: In the study sample, 17.6% had ≤ high school education while 36.1% earned <$25,000; income and education were poorly correlated (r= 0.355). Among this sample (mean age= 46.4, range= 18-88), the prevalence of outcomes was: diabetes (9.4%), MI (5.0%), CVA (0.9%), and angina (4.5%). Unadjusted, low education was significantly associated with reporting an aggregate outcome (χ² =15.6; p=0.0004) whereas income was not (χ² =0.79; p=0.37). Low education continued to be significantly associated with increased likelihood of reporting an aggregate outcome (OR 5.057; 95% CI 1.73-14.82) whereas income was not significantly associated with reporting an aggregate outcome (OR 0.91; 95% CI: 0.39-2.12) even after adjustment. Conclusion: This is the first known study documenting that low educational attainment is associated with higher likelihood of reported cardiovascular disease among Deaf individuals. Higher income did not appear to provide a cardiovascular protective effect, unlike in the general population. This may be partially explained by the poor correlation between educational attainment and income in the study sample. Effective and accessible health communication and education with Deaf individuals with lower educational attainment could be addressed by the use of language-concordant providers and interpreters and following principles of clear communication (e.g. teach-back) to address ongoing cardiovascular health disparities.

scholarly journals Equity in statin use in New Zealand

2014 ◽  
Vol 6 (1) ◽  
pp. 17 ◽  
Author(s):  
Pauline Norris ◽  
Simon Horsburgh ◽  
Gordon Becket ◽  
Shirley Keown ◽  
Bruce Arroll ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
New Zealand ◽  
Socioeconomic Position ◽  
Risk Groups ◽  
Cross Sectional Study ◽  
Age Group ◽  
Cross Sectional ◽  
Lower Socioeconomic ◽  
Statin Prescription ◽  
Statin Use

INTRODUCTION: Preventive medications such as statins are used to reduce cardiovascular risk. There is some evidence to suggest that people of lower socioeconomic position are less likely to be prescribed statins. In New Zealand, Maori have higher rates of cardiovascular disease. AIM: This study aimed to investigate statin utilisation by socioeconomic position and ethnicity in a region of New Zealand. METHODS: This was a cross-sectional study in which data were collected on all prescriptions dispensed from all pharmacies in one city during 2005/6. Linkage with national datasets provided information on patients’ age, gender and ethnicity. Socioeconomic position was identified using the New Zealand Index of Socioeconomic Deprivation 2006. RESULTS: Statin use increased with age until around 75 years. Below age 65 years, those in the most deprived socioeconomic areas were most likely to receive statins. In the 55–64 age group, 22.3% of the most deprived population received a statin prescription (compared with 17.5% of the mid and 18.6% of the least deprived group). At ages up to 75 years, use was higher amongst Maori than non-Maori, particularly in middle age, where Maori have a higher risk of cardiovascular disease. In the 45–54 age group, 11.6% of Maori received a statin prescription, compared with 8.7% of non-Maori. DISCUSSION: Statin use approximately matched the pattern of need, in contrast to other studies which found under-treatment of people of low socioeconomic position. A PHARMAC campaign to increase statin use may have increased use in high-risk groups in New Zealand. KEYWORDS: Ethnic groups; New Zealand; prescriptions; socioeconomic status; statins

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