African-Americans less likely to receive statin therapy at recommended levels, study finds

June 13, 2018 – Researchers used data from the PALM registry to compare treatment of African-American and white patients.

African-Americans are less likely to receive statin therapy at levels recommended by current guidelines, according to a study by DCRI researchers published this week in JAMA Cardiology.

Michael NannaDemographics, clinical characteristics, socioeconomic status, patient beliefs, and clinician factors all contributed to this discrepancy, the researchers said.

African-American patients are at higher risk for atherosclerotic cardiovascular disease, yet previous research has shown that African-Americans are less likely to receive statin therapy when indicated compared with white individuals. The reasons for these differences are not well understood.

In this study, led by Duke Cardiology Fellow Michael Nanna, MD, researchers sought to better understand the treatment patterns of African-Americans receiving statin therapy. To do so, they examined data from the Patient and Provider Assessment of Lipid Management (PALM) registry. PALM is a repository of patients from across the United States with cardiovascular risk factors warranting consideration of lipid-lowering therapies, as well as patients already on statin therapy.

Using the PALM registry, Nanna and his colleagues identified 5,689 patients from 138 health care practices who were eligible for statin therapy. Of these patients, 806 were African-American (14.2 percent) and 4,883 were white (85.8 percent). Among those treated, just 269 African-American patients received statin therapy at the recommended level (33.3 percent), compared to 2,145 white patients (43.9 percent). The median low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African-American than white individuals.

The researchers found that African-American patients were less likely than white patients to believe statins were safe (36.2 percent vs. 57.3 percent) or effective (70.0 percent vs. 74.4 percent). African-Americans were also less likely to trust their clinician (82.3 percent vs. 93.8 percent).

These differing beliefs about statins, cholesterol, and medical care may contribute to ongoing disparities in statin therapy, the researchers noted.

“What we found is that this is a complex issue,” Nanna said. “The treatment differences are partially explained by clinical factors but socioeconomic, patient belief and provider characteristics all contributed as well. What this means is that in order to identify how to improve our treatment, we will need to take a multi-dimensional approach.

“Ultimately, we need to build trust with our patients, be consistent in our application of guideline-recommendations and educate both our clinicians and patients on the appropriate therapies for risk reduction.”

In addition to Nanna, other Duke authors included the DCRI’s Ann Marie Navar, MD, PhD; Pearl Zakroysky, MPH; Qun Xiang, MS; Tracy Y.Wang, MD, MHS, MSc; and Eric D. Peterson, MD, MPH.