Abstract P128: Statin Prescribing, Switching, and Low-density Lipoprotein Cholesterol Goal Attainment Across Racial/Ethnic Groups With Atherosclerotic Cardiovascular Disease
Authors: Romanelli Robert J , Ito Matthew J , Karalis Dean G , Huang Hsiao- Ching , Iorga Serban R , Kam Ivy , Thompson Stephen F , Azar Kristen M 
Published: March 2019

Introduction:
Statins are effective in reducing low-density lipoprotein cholesterol (LDL-C) and preventing cardiovascular (CV) events in patients with a history of atherosclerotic CV disease (ASCVD), irrespective of race/ethnicity (R/E). Differences in statin utilization, including prescribing and switching, in relationship to LDL-C goal attainment by R/E has not been well studied.

Hypothesis:
We expect differences in attaining LDL-C <70 mg/dL (goal) by R/E and that differences in goal attainment are associated with patterns in statin utilization.

Methods:
We selected patients ≥40 years of age in the Sutter Health electronic health records (EHR) with ASCVD based on International Classification of Diseases 9/10 diagnoses (2006-2016), with a new statin prescription (defined as no evidence of a statin in the year prior) and LDL-C values. Patient demographics and clinical characteristics at statin initiation (index) were extracted. We examined differences in LDL-C goal attainment after 1-year follow-up (mean ~16 months) from index date by R/E and initial statin intensity (low/moderate [L/MIS] vs. high [HIS]) using logistic regression. Differences in rates of statin intensity increases or decreases were estimated during follow-up by R/E using negative binominal regression. Incident rate ratios (IRR) were calculated. All models were adjusted for demographic and clinical characteristics.

Results:
From a database of 3.1 million patients, 241,912 had ASCVD and 11,499 met inclusion criteria (66% non-Hispanic white [NHW], 9% Asian, 3% black, 8% Hispanic, 14% other/unknown). About 18% of patients initiated treatment on HIS and 82% on L/MIS statin, with no significant differences by R/E. LDL-C goal was attained by 33% of patients, overall, and 42% and 30% on HIS and L/MIS, respectively. Of those on HIS, Asians were more likely to have statin intensity decreases than NHWs (IRR:1.89) but were also more likely to attain LDL-C goal than NHWs (58% vs. 39%). Among those on L/MIS, intensity increases were not different by R/E, yet Asians were still more likely to attain goal than NHWs (38% vs. 30%), whereas black patients were less likely (24%). Hispanics on L/MIS were more likely to have intensity decreases (IRR: 1.44), yet similarly met goal (33%) as compared with NHWs. When included in statistical models, statin intensity increases and decreases were independent predictors of higher and lower odds of goal attainment, respectively, but did not alter relationships between R/E and goal attainment.

Conclusions:
In this ASCVD cohort receiving statins, LDL-C goal attainment differed by R/E, and was highest among Asians and lowest among black patients, however this difference in goal attainment does not appear to be related to differences in statin utilization. Other modifiable factors, such as adherence or access to care, need to be investigated further to improve goal attainment across all R/E groups.