Race and Socioeconomic Differences Associated With Changes in Statin Eligibility Under the 2013 American College of Cardiology/American Heart Association Cholesterol Guidelines.

Autor:	Verma AA; From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael's Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital-McGill University Health Centre, Montreal, Canada (A.D.S.); and Harvard Center for Population and Development Studies, Boston, MA (F.R.)., Jimenez MP; From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael's Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital-McGill University Health Centre, Montreal, Canada (A.D.S.); and Harvard Center for Population and Development Studies, Boston, MA (F.R.)., Subramanian SV; From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael's Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital-McGill University Health Centre, Montreal, Canada (A.D.S.); and Harvard Center for Population and Development Studies, Boston, MA (F.R.)., Sniderman AD; From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael's Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital-McGill University Health Centre, Montreal, Canada (A.D.S.); and Harvard Center for Population and Development Studies, Boston, MA (F.R.)., Razak F; From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael's Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital-McGill University Health Centre, Montreal, Canada (A.D.S.); and Harvard Center for Population and Development Studies, Boston, MA (F.R.). fahad.razak@mail.utoronto.ca.
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2017 Sep; Vol. 10 (9).
DOI:	10.1161/CIRCOUTCOMES.117.003764
Abstrakt:	Background: The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines expanded eligibility criteria for statins. We examined race and socioeconomic differences associated with these changes. Methods and Results: This was an observational study of adults between 40 and 75 years of age using data from the National Health and Nutrition Examination Surveys between 2005 and 2012. Change in eligibility for statins was assessed based on the third adult treatment panel criteria and the 2013 ACC/AHA guidelines. Differences relating to self-reported race, income, education, and insurance status were assessed in models that were adjusted for age and each of the other factors. Statin eligibility increased among all race, education, and income groups. Becoming newly eligible for statins was more likely for black people (25.8% newly eligible; adjusted odds ratio, 3.8; P <0.001), people of other races (18.7%; adjusted odds ratio, 2.5; P <0.001), those with no more than high-school education (17.3%; adjusted odds ratio, 1.7; P =0.001), and those with no health insurance (17.6%; adjusted odds ratio, 1.5; P <0.001) compared with white people (14.5%), those who completed college (13.0%), and those with health insurance (15.6%). Income differences were not significant after adjusting for age, race, and education. These differences were driven by the prevalence of elevated predicted cardiac risk and diabetes mellitus. Among the US adults who were newly eligible for statins, 12.4 million (66.3%) were nonwhite, had lower education or lower income, and 3.0 million (16.1%) had no health insurance. Race and socioeconomic differences in statin eligibility were more pronounced under the 2013 ACC/AHA guidelines than under third adult treatment panel. If treatment disparities remain unchanged, the 2013 ACC/AHA guidelines increase the number of US adults who are eligible but do not receive statins by 3.0 million nonwhites, 3.6 million with no more than high-school education, and 4.1 million in the lowest 2 income quartiles. Conclusions: The 2013 ACC/AHA guidelines increase statin eligibility most among adults with nonwhite race, socioeconomic disadvantage, and no health insurance. Without improving access to healthcare, the potential gains from expanding indications for cardioprotective medications will not be realized. (© 2017 American Heart Association, Inc.)
Databáze:	MEDLINE
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