MedicalResearch.com Interview with:
Michael G. Nanna, MD
Fellow, Division of Cardiology
Duke University Medical Center
MedicalResearch.com: What is the background for this study?
Response: We know that African Americans are at higher risk for cardiovascular disease than white patients. We also know that African American individuals have been less likely to receive statin therapy compared to white individuals in the past. However, the reasons underlying these racial differences in statin treatment are poorly understood. We set out to determine if African American individuals in contemporary practice are treated less aggressively than whites and, if so, we wanted to investigate potential reasons why this might be the case.
MedicalResearch.com: What are the main findings?
Response: What we found was that African American individuals were somewhat less likely than white individuals to be treated with a statin overall and also less likely to receive a statin at a guideline-recommended intensity. African American’s median LDL levels were also higher than white individuals. While the differences in statin treatment were partially explained by clinical factors, other factors also contributed.
For example, we identified that African-American patients were less likely than white patients to believe statins were safe or effective and less likely to trust their clinician. Importantly, we were able to identify potential differences in baseline demographics, clinical characteristics, patient beliefs and provider characteristics which, taken together, accounted for the observed treatment differences.
MedicalResearch.com: What should readers take away from your report?
Response: The first take away would be that even in contemporary medicine, African American individuals are less likely to be treated with statins than whites. Though it appears the gap is closing, this is an important issue that needs to continue being addressed.
The second is that our study was able to look much more deeply into the reasons why those differences exist. What we found is that this is a complex issue. The 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 clinicians and patients on the appropriate therapies for risk reduction.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We clearly need to work towards a multi-disciplinary approach. Its worth noting that, even among white individuals, a quarter of patients that should be on a statin, weren’t on a statin. So there is room to improve in the treatment of both African American and white patients. I believe we need to set up health systems where all patients who are eligible have the opportunity to get treated. For example, there can be alerts in the electronic health record to identify patients who require treatment. If we raise the quality of care for all individuals, these treatment gaps will hopefully improve. As far as future research goes, I think a deeper dive into the role of clinician beliefs and/or treatment variation between sites would help us get closer to the answers we seek.
Disclosures: I have no personal disclosures to make. The study overall was funded by Sanofi and Regeneron as well as the NHLBI via Dr. Navar’s K award (grant K01HL133416).
Nanna MG, Navar AM, Zakroysky P, et al. Association of Patient Perceptions of Cardiovascular Risk and Beliefs on Statin Drugs With Racial Differences in Statin UseInsights From the Patient and Provider Assessment of Lipid Management Registry. JAMA Cardiol. Published online June 13, 2018. doi:10.1001/jamacardio.2018.1511
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