Abstract P324: Implications of ACC/AHA Cholesterol Guidelines on Statin Underutilization for Prevention of Cardiovascular Disease in Diabetes Mellitus among Several U.S. Networks of Community Health Centers
Introduction: Little is known about statin underuse among diabetes (DM) patients cared for in community health centers (CHCs), which tend to serve socioeconomically disadvantaged populations. Implications of the recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines on preexisting gaps in statin treatment in this population are unclear.
Hypothesis: Substantial statin underutilization will exist regardless of differences between guidelines.
Methods: We included 32,440 adults (45% male, 63% non-white, 28% uninsured/Medicaid) with DM aged 40 to 75 years who received care within 16 CHC groups in eleven states in the Community Health Applied Research Network (CHARN) during 2013. Statin prescribing was analyzed as a function of concordance with the National Cholesterol Education Program Adult Treatment Panel (ATPIII) 2001 guideline and ACC/AHA 2013 guideline.
Results: More patients were concordant with the ACC/AHA (52.8%) versus ATPIII (36.2%) guideline. Female gender was independently associated with lower concordance for both guidelines [OR 0.90 CI (0.85-0.94) and OR 0.84 CI (0.80-0.88) respectively]. Black race was associated with lower concordance with ATPIII but not ACC/AHA. Being insured, Asian/Pacific Islander or primarily Spanish speaking were associated with greater concordance for both guidelines. 35% (11526/32440) of the cohort were concordant with neither guideline (Figure), the majority (80%) having no statin prescribed. 28% (9168/32440) were concordant with ACC/AHA guidelines but not ATPIII guidelines. 8.5% of these patients had an LDL >160 despite having a medium or high intensity statin prescribed. 12% (3772/32440) were concordant with ATPIII but not ACC/AHA guidelines. Most of these patients had an LDL between 70-99 mg/dl with no or a low intensity statin prescribed.
Conclusions: Opportunities exist to improve cholesterol management in DM patients in CHCs. Addressing care gaps could improve cardiovascular disease prevention in this high risk population.
Author Disclosures: E. Akhabue: None. S.S. Rittner: None. J.E. Carroll: None. P.M. Crawford: None. L. Dant: None. R. Laws: None. M.C. Leo: None. J. Puro: None. S.D. Persell: None.
- © 2017 by American Heart Association, Inc.