Abstract 11550: Racial/Ethnic Differences in Statin Prescription and Clinical Outcomes Among Hospitalized Coronary Heart Disease Patients
Background: Racial/ethnic disparities in coronary heart disease (CHD) outcomes may be related to differential use of preventive medications, but data from real world settings are limited. The purpose of this study was to evaluate the association between race/ethnicity, statin prescription, and clinical outcomes among hospitalized CHD patients, adjusted for confounders.
Methods: This was a 1 year prospective study of patients with existing CHD without a documented contraindication to statin (N=3067, 35% black/Hispanic, 65% white/Asian, 35% female) that participated in an NHLBI clinical outcomes study of patients admitted to a cardiovascular service. Baseline clinical/medication data and 1 year outcomes (rehospitalization/death) were documented by electronic medical record, National Death Index, and standardized mail survey. Logistic regression was used to evaluate associations between race/ethnicity, statin prescription, and outcomes adjusted for demographics/comorbidities.
Results: Black/Hispanic patients were more likely to be rehospitalized/dead at 1 year (OR=1.23; 95%CI=1.06-1.43) and less likely to report statin use prior to admission (62% vs. 72%; p<0.0001) than whites/Asians, but statin prescription was similar at discharge among blacks/Hispanics (81%) vs. whites/Asians (84%). Differential statin use prior to admission was independent of measured confounders (OR=0.60; 95%CI=0.49-0.72). Statin use prior to admission or statin prescription at discharge did not explain racial/ethnic differences in clinical outcomes. Black/Hispanic patients were more likely than whites/Asians to have prior/current diabetes, renal failure, stroke, and to be smokers (p<0.05). The increased odds of death/rehospitalization at 1 year in minorities vs. whites/Asians (adjusted OR=1.07; 95% CI=0.91-1.27) was explained by demographic and comorbid conditions and not by statins.
Conclusions: In this study of hospitalized patients with existing CHD, prior statin use and statin prescription at discharge did not explain racial/ethnic disparities in clinical outcomes at 1 year. Efforts to reduce CHD rehospitalizations should consider the greater burden of comorbidities among racial/ethnic minorities.
- © 2013 by American Heart Association, Inc.