Abstract P185: Racial Disparities in Statin Use Among Persons With HIV: The HIV Electronic Comprehensive Cohort of CVD Complications (HIVE-4CVD)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Avery Cowen ◽  
Anna Pawlowski ◽  
Daniel Schneider ◽  
Donald M Lloyd-Jones ◽  
Matthew J Feinstein
Keyword(s):  
Diabetes Mellitus ◽  
Statin Therapy ◽  
Odds Ratio ◽  
Total Cholesterol Level ◽  
Insurance Status ◽  
Black And White ◽  
Ascvd Risk ◽  
Adjusted Logistic Regression ◽  
Diabetes Mellitus 2 ◽  
Statin Use

Background: Few studies have evaluated utilization of ASCVD-preventive therapies, such as statins, among PLWH. Although disparities by race, sex, and insurance status in statin utilization exist in the general population, the extent to which these disparities exist among PLWH - a population with a distinct demographic and risk factor profile - is unknown. Methods: We compared statin utilization rates by race for the 3252 black and white PLWH in HIVE-4CVD who received care at Northwestern Medicine between 1/1/2000 and 5/17/2017. Persons were considered as having an indication for statin therapy if they had one or more of the following: (1) diabetes mellitus; (2) coronary heart disease; (3) a total cholesterol level of ≥240 mg/dL; and/or (4) calculated 10-year ASCVD risk of ≥7.5%. We compared statin utilization between black and white PLWH overall and stratified by insurance status. Multivariable-adjusted logistic regression adjusted for age, sex, and insurance status then was used to compare statin utilization for black vs. white PLWH with statin indications. Results: Of 1680 white PLWH and 1572 black PLWH, 610 whites (36.3%) and 508 blacks (32.3%) had at least one indication for statin therapy. Among PLWH with statin indications, whites were significantly more likely than blacks to be taking statins (60.0% vs. 42.1%, p<0.001; Figure 1). This pattern persisted when analyses were stratified by insurance status. After adjustment for age, sex, and insurance status, black PLWH with statin indications were significantly less likely than their white counterparts to be taking statins (Odds ratio for blacks vs. whites = 0.56 , 95% CI 0.46-0.68, p<0.001). Conclusions: Among PLWH with indications for statin use, blacks were significantly less likely than whites to be taking statins, even after adjustment for age, sex, and insurance status. Further studies of real-world statin use among PLWH are needed to understand reasons for disparities.

Abstract 17321: Guideline Recommended Statin Therapy Implementation and Cardiovascular Outcomes: Insights From a Multi-Site Healthcare Primary Prevention Cohort

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anum Saeed ◽  
Jianhui Zhu ◽  
Floyd W Thoma ◽  
Oscar C MARROQUIN ◽  
Aryan Aiyer ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
Healthcare System ◽  
Risk Groups ◽  
Prescription Practices ◽  
Ascvd Risk ◽  
Mean Time ◽  
Risk Categories ◽  
Statin Use

Background: The 2013 and 2018 ACC/AHA cholesterol guidelines recommend using the 10-year ASCVD risk to guide statin therapy for primary prevention. Evidence of real-world consequences of non-adherence to these guidelines in primary prevention cohorts is limited. We investigated outcomes based on statin use in a large healthcare system, stratified by 10y ASCVD risk. Methods: Statin prescription practices in patients without CAD or ischemic stroke were evaluated ( 2013-2019). Patient categories constructed per the ASCVD risk were; Borderline (5%-7.4%), Intermediate (7.5%-19.9%) or High (≥20%). Guideline-directed statin intensity (GDSI) , at time of first event, was defined as; “none or any intensity” for borderline , “at least moderate” for Intermediate and high -risk groups. Mean (±SD) time to start/change to GD therapy from first interaction in healthcare, ASCVD incident rates [IR] and mortality were calculated across risk categories stratified by statin utilization. Results: Among 282,298 patients (mean age ~50y), 29,134 (10.3%), 63,299 (22.4%) and 26,687 (9.5%) were borderline, intermediate and high risk, respectively. Within intermediate-risk, 27,358 (43%) and 8,300 (31%) of high-risk never received any statin. Only 17,519 (65.6%) high-risk subjects who were prescribed statin, received GDSI [mean time ~1.8y]. A graded increase in ASCVD and mortality IRs was seen in all risk categories comparing statin versus no statin use (Table). Conclusions: In a multi-site healthcare network, over one-third of statin-eligible patients were not prescribed statin therapy. In eligible patients, who ultimately received statins, mean time to GDSI was ~2yrs. The consequences of non-adherence to guidelines is illustrated with greater incident ASCVD events and mortality among those patients not treated with statin therapy. Further research can define identify barriers and develop healthcare system strategies to optimize preventive therapies.

Abstract P071: Association Between Polyunsaturated Fat Consumption and Hypertension among Statin Users and Non-users

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
James N Kiage ◽  
Uchechukwu K Sampson ◽  
Loren Lipworth ◽  
Sergio Fazio ◽  
Qilu Yu ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Statin Therapy ◽  
Inverse Association ◽  
Cardiovascular Risk Reduction ◽  
Cross Sectional ◽  
Pufa Intake ◽  
Black And White ◽  
Beneficial Effects ◽  
Fat Consumption ◽  
Statin Use

Background: Numerous prospective studies suggest inverse associations between intake of polyunsaturated fatty acids (PUFA) and cardiovascular outcomes. However, recent randomized studies have failed to demonstrate these benefits. One of the prevailing hypotheses is that the beneficial effects of PUFA may now be masked by the widespread use of statins, which lower lipids and blood pressure and are potent modulators of cardiovascular risk. Hypothesis: We tested the hypothesis that the association between PUFA and hypertension varies by statin use. Methods and Results: We conducted a cross-sectional analysis based on 74,658 black and white men and women in the Southern Community Cohort Study. Intake of PUFA was assessed by a food-frequency questionnaire, while history of diagnosed hypertension and statin use were self-reported. The mean±SD age was 52±9 years, body mass index was 30±8 kg/m 2 , and energy intake from PUFA was 8.0±1.8%. Sixty percent of the participants were women and 68% were African Americans. Hypertension (55%), statin use (16%), smoking (40%) and alcohol use (55%) were common in this cohort. In an adjusted logistic model with hypertension as the dependent variable, there was no interaction between PUFA intake and statin therapy ( P =0.13), whereas a significant inverse association was evident between PUFA intake and hypertension among non-statin users ( P for trend = 0.03) but not among statin users ( P for trend = 0.36) ( Table ). Conclusion: In conclusion, these results support a beneficial effect of PUFA consumption on hypertension, which is only apparent in the absence of statin therapy. These findings underscore the need to stratify by statin therapy when randomizing participants to cardiovascular interventions and support the notion that PUFA may be important in cardiovascular risk reduction in patients where statin therapy is not an option.

Abstract 18914: Comparison of Statin Eligibility Using the Pooled Cohort Equations, ATP-III Framingham and Reynolds Risk Scores Among Adults Who Experienced ASCVD Events: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tamar Polonsky ◽  
David Couper ◽  
Amy Yang ◽  
Philip Greenland ◽  
Salim Virani ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Lower Risk ◽  
Primary Outcome ◽  
Blood Cholesterol ◽  
Risk Scores ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Estimated Risk ◽  
Ascvd Risk ◽  
Statin Use

Background: The 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol recommended initiating statin therapy when an individual’s 10-year estimated ASCVD risk ≥7.5% We sought to determine whether adults who eventually experienced ASCVD events were more likely to be identified as having ≥7.5% risk using the ACC/AHA’s Pooled Cohort Equations (PCE) compared to the ATP III-Framingham (FRS) and Reynolds risk scores (RRS). Methods: We used data from the biracial Atherosclerosis Risk in Communities Study (ARIC) visit 4 (1996-1998) because hsCRP was measured at this exam. We excluded participants with an ASCVD event prior to visit 4, diabetes, statin use at visit 4, age>74, LDL-C >190 mg/dl, or missing data. Published models for the PCE, ATP III-FRS, and RRS estimated risk. We defined statin eligibility as an estimated 10-year risk ≥7.5% for the PCE and RRS, and ≥10% for the ATP III-FRS. The primary outcome for each score was based on the outcomes originally used to derive the scores: ATP III-FRS (MI or CHD death), PCE (MI, CHD death, stroke) and RRS (MI, CHD death, stroke and revascularization). Results: Using the PCE, 2592 participants had an estimated risk ≥7.5% and 2760 <7.5%. The median age among those with estimated risk ≥7.5% was 66; 19% were black and 35% were women. Over a median of 11 years 304 CHD events, 201 strokes and 432 revascularizations occurred. With all 3 risk scores >80% of men who experienced events had an estimated risk ≥7.5% (see Table). In contrast, a much smaller proportion of women who experienced events had an estimated risk ≥7.5%, although the PCE yielded the highest proportion (52%). Conclusions: A cutoff of ≥7.5% 10-year ASCVD risk identified the majority of male participants in ARIC who experienced subsequent ASCVD events regardless of the risk score used. Substantially fewer women who experienced events were identified. Lower risk cutoffs or additional markers of ASCVD risk may be required when making decisions about statin therapy for women.

Abstract 15098: New-Onset Diabetes Mellitus Risk in Statin Users Depends on Baseline HemoglobinA1c Value - Results of VA Database Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anna P Ziganshina ◽  
Darren Gemoets ◽  
Laurence Kaminsky ◽  
Aidar R Gosmanov
Keyword(s):  
Diabetes Mellitus ◽  
Mortality Rate ◽  
Statin Therapy ◽  
Baseline Hba1c ◽  
Onset Diabetes ◽  
All Cause Mortality ◽  
Us Veterans ◽  
New Onset Diabetes Mellitus ◽  
Statin Use ◽  
New Onset

Introduction: Statin use in non-diabetic patients is associated with an increased risk of development of new-onset diabetes mellitus (NODM). However, little is known if baseline hemoglobin A1c (HbA1c) can affect diabetogenic risks and mortality benefits of statin therapy. Methods: In a retrospective cohort study between 01/2011 and 12/2018 we collected the data of 152358 non-diabetic US veterans on statin and not on statin therapy who had available baseline HbA1c value and full demographic and clinical information prior to DM diagnosis. The risk of statin-induced DM and all-cause mortality rate were assessed in the whole cohort and based on baseline HbA1c categories: ≤5.6%, 5.7-5.9% and 6.0-6.4%. DM rate and mortality rate were calculated by Cox proportional hazards model adjusted for case-mix. Results: After mean follow up of 6.89 (SD 2.26) years in non-statin users and 3.85 (SD 2.29) years in statin users and adjustments for multiple covariates such as age, gender, ethnicity, obesity, hypertension (HTN), cardiovascular disease, and metformin use, we found that the rate of statin-induced DM depends on baseline HbA1c (Table 1). Analysis by HbA1c categories showed that NODM rate is inversely related to HbA1c level, while statin use in patients with HbA1c 6.0-6.4% was not associated with increased rate of NODM. We did not observe increase in all-cause mortality in statin users and statin users with HTN across HbA1c categories. Atorvastatin use was associated with decrease in all-cause mortality in HTN patients (Table 1). Conclusions: The results of this largest to date analysis of non-diabetic US veterans closely matched for baseline characteristics suggest that the rate of statin-induced DM depends on baseline HbA1c. The significant increase in NODM rate is only observed in patients with baseline HbA1c <6.0% regardless of statin type prescribed. The increased NODM risk is not associated with all-cause mortality in statin users in general including patients with HTN.

scholarly journals Optimizing Atherosclerotic Cardiovascular Disease Risk Estimation for Veterans With Diabetes Mellitus

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Sridharan Raghavan ◽  
Yuk-Lam Ho ◽  
Jason L. Vassy ◽  
Daniel Posner ◽  
Jacqueline Honerlaw ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Statin Therapy ◽  
Risk Estimation ◽  
Model Performance ◽  
Atherosclerotic Cardiovascular Disease ◽  
Electronic Health Record Data ◽  
C Statistic ◽  
Ascvd Risk ◽  
Electronic Health

Background: Estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk in diabetes mellitus patients is used to guide primary prevention, but the performance of risk estimators (2013 Pooled Cohort Equations [PCE] and Risk Equations for Complications of Diabetes [RECODe]) varies across populations. Data from electronic health records could be used to improve risk estimation for a health system’s patients. We aimed to evaluate risk equations for initial ASCVD events in US veterans with diabetes mellitus and improve model performance in this population. Methods AND RESULTS: We studied 183 096 adults with diabetes mellitus and without prior ASCVD who received care in the Veterans Affairs Healthcare System (VA) from 2002 to 2016 with mean follow-up of 4.6 years. We evaluated model discrimination, using Harrell’s C statistic, and calibration, using the reclassification χ 2 test, of the PCE and RECODe equations to predict fatal or nonfatal myocardial infarction or stroke and cardiovascular mortality. We then tested whether model performance was affected by deriving VA-specific β-coefficients. Discrimination of ASCVD events by the PCE was improved by deriving VA-specific β-coefficients (C statistic increased from 0.560 to 0.597) and improved further by including measures of glycemia, renal function, and diabetes mellitus treatment (C statistic, 0.632). Discrimination by the RECODe equations was improved by substituting VA-specific coefficients (C statistic increased from 0.604 to 0.621). Absolute risk estimation by PCE and RECODe equations also improved with VA-specific coefficients; the calibration P increased from <0.001 to 0.08 for PCE and from <0.001 to 0.005 for RECODe, where higher P indicates better calibration. Approximately two-thirds of veterans would meet a guideline indication for high-intensity statin therapy based on the PCE versus only 10% to 15% using VA-fitted models. Conclusions: Existing ASCVD risk equations overestimate risk in veterans with diabetes mellitus, potentially impacting guideline-indicated statin therapy. Prediction model performance can be improved for a health system’s patients using readily available electronic health record data.

Abstract 16657: Guideline Recommended Statin Therapy and Sex Based Cardiovascular Disease Outcomes: Data From a Multi-site Healthcare Network Primary Prevention Cohort

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anum Saeed ◽  
Jianhui Zhu ◽  
Floyd W Thoma ◽  
Oscar C MARROQUIN ◽  
Malamo E Countouris ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
Healthcare System ◽  
Stroke Risk ◽  
Cox Regression ◽  
High Risk Women ◽  
Increased Risk ◽  
Ascvd Risk ◽  
Statin Use

Introduction: Statin therapy has been shown to reduce ASCVD morbidity and mortality. Evidence on statin utilization per the ACC/AHA cholesterol guidelines and outcomes are limited in primary prevention cohorts of women. We investigated statin use outcomes per 10-year ASCVD risk in a large healthcare system stratified by sex. Methods: Statin prescription in patients without CAD (MI or revascularization) or ischemic stroke were evaluated (2013-2019). Risk categories per the ASCVD risk were defined as: Borderline (5%-7.4%), Intermediate (7.5%-19.9%) or High (≥20%). Guideline-directed statin intensity (GDSI), at time of first event, was defined as: “at least moderate” for Intermediate and high -risk groups. Cox regression hazard ratios (HR) [95% CI] were calculated for statin use and outcomes (MI, stroke and composite ASCVD events) stratified by gender. Interaction terms (age ≥75y and sex) were applied. Results: Among 159,100 women (out of 282,298 patients; mean age ~51y), 15,153 (9.5%), 26,697 (16.8%) and 10,583 (6.7%) were categorized as borderline, intermediate and high risk, respectively. Only 9,277 (35%) intermediate and 4,893 (46%) of high-risk women received any intensity of statin. High risk women (vs men) on GDSI, had lower association with CAD events (HR 0.8 [0.7-0.9]) and increased stroke risk (HR 1.2 [1.1-1.4]) ( Table). Intermediate and high-risk women (on <GD statin or no statin) had higher stroke risk than those on GD statin (p for interaction <0.001 ). Older women (≥75y) on “no statin” (vs GD statin) had independently increased risk of CAD (HR 1.30[1.1-1.6]) (p interaction <0.001) . Conclusions: In a real-world primary prevention cohort, women on statin therapy had significantly improved ASCVD outcomes and lower mortality. However, approximately one-fourth of statin-eligible women were not prescribed any statin therapy. Further research can develop healthcare system strategies to optimize under-treatment of women for ASCVD prevention.

scholarly journals Effect of Statin Therapy on Diabetes Retinopathy in People With Type 2 Diabetes Mellitus: A Meta-Analysis

2021 ◽  
Vol 27 ◽  
pp. 107602962110401
Author(s):  
Jun Liu ◽  
Yi-Ping Wu ◽  
Jun-Juan Qi ◽  
Zeng-Ping Yue ◽  
Cheng-Dong Hu
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Statin Therapy ◽  
Meta Analysis ◽  
Elevated Risk ◽  
Cochrane Library ◽  
Diabetes Retinopathy ◽  
Statin Use

Objective: We tried to find the relationship between statin and diabetes retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods: We searched the databases of PubMed, EMBASE, and the Cochrane Library for eligible studies reporting on the relationships between statin use and DR, from inception to September 25, 2020. The terms searched including Diabetes Mellitus, Type 2, Hydroxymethylglutaryl-CoA Reductase Inhibitors, and Diabetic Retinopathy. We expressed the results as the odds ratios (ORs) with 95% confidence intervals (CIs) which were calculated using a random-effects model. Results: A total of 6 eligible studies, including 43 826 patients, were included in the meta-analysis. The meta-analysis showed that statin was not associated with elevated risk of DR [OR = 0.96 (95% CI: 0.80-1.16), P = .68]. Similarly, no differences were found between statin and placebo in participants ≥500 [OR = 0.98 (95% CI: 0.80-1.21)] or participants <500 [OR = 0.90 (95% CI: 0.49-1.66)]. Further, we conducted a meta-analysis to study the effect of statin therapy on DR in people with type 2 diabetes according to age and found that statin use was associated with a decreased risk of DR in patients with type 2 diabetes 40 years of age or older [OR = 0.87 (95% CI: 0.82-0.92)]. Conclusion: Our meta-analysis revealed that statin was not associated with elevated risk of DR in patients with T2DM. Moreover, statin use was associated with a lower incidence of DR in patients with type 2 diabetes 40 years of age or older.

scholarly journals Pharmacist-Led Programs to Increase Statin Prescribing: A Narrative Review of the Literature

Pharmacy ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 13
Author(s):  
Mary Elkomos ◽  
Raha Jahromi ◽  
Michael S. Kelly
Keyword(s):  
Statin Therapy ◽  
Narrative Review ◽  
Clinical Settings ◽  
Atherosclerotic Cardiovascular Disease ◽  
Specific Patient ◽  
Drug Therapy Management ◽  
Ascvd Risk ◽  
Statin Adherence ◽  
Multiple Intervention ◽  
Statin Use

Statins are lipid-lowing medications shown to reduce cardiovascular events and are recommended for specific patient populations at elevated risk of atherosclerotic cardiovascular disease (ASCVD). Despite the demonstrated efficacy of statins for reducing ASCVD risk, and guidance on which populations should receive statin therapy, a substantial portion of eligible patients are not prescribed statin therapy. Pharmacists have attempted to increase the number of eligible patients receiving appropriate statin therapy through a variety of interventions and across several clinical settings. In this article, we highlight multiple studies evaluating the effectiveness of pharmacist-led interventions to improve statin use. A total of seven studies were selected for this narrative review, demonstrating the effectiveness and barriers of different statin-initiation programs delivered by pharmacists to increase statin use in eligible patients. Among the interventions assessed, a combination of provider communicating and statin prescribing through collaborative drug therapy management (CDTM) appear to the be the most useful at increasing statin use. Pharmacists can significantly improve statin use rates among eligible patients through multiple intervention types and across different clinical settings. Further studies should evaluate continued statin adherence and clinical outcomes among patients served by pharmacists.

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