Beliefs About Statins, Trust in Doctor Affect Statin Prescription Disparities by Race

Statin underprescribing in African Americans was attributed not only to demographic and socioeconomic factors in a large registry study but also seemed related to greater misunderstanding of statin safety and efficacy and mistrust of their physicians compared with white patients, a new analysis suggests.

Compared with whites, African Americans were less likely to be treated with a statin or to receive high-intensity statins when appropriate per guidelines, which likely contributed to their overall higher levels of low-density lipoprotein cholesterol (LDL-C) in an analysis of statin-eligible patients in the national Patient and Provider Assessment of Lipid Management (PALM) registry.

Also compared with whites, African Americans were more likely to see themselves as at lower cardiovascular risk than others. They were also less likely to believe statins are effective "and far less likely than white participants to believe statins are safe," conclude authors of a report published June 13 in JAMA Cardiology.

Moreover, "while most African American and white individuals reported completely trusting their clinicians, there were differences by race, with fewer African American patients reporting complete trust in their clinician than white patients did,"  say the researchers, with lead author Michael G. Nanna, MD, Duke University Medical Center, Durham, North Carolina.

There were lots of clinical, demographic, and socioeconomic differences between African Americans and whites in the analysis, which partially explained the differences in statin prescribing, Nanna told theheart.org | Medscape Cardiology. "But patient beliefs and provider characteristics also contributed," he said.

"No one category of confounders fully accounted for the treatment difference. So this is a multidimensional complex issue that's going to require a multifaceted approach," Nanna said.

"Perceptions about statin safety are an important target for us in terms of patient education," he observed. "We have to consider our patients' perceptions about statins when prescribing them. We have to consider their understanding of their own risk, as well as their priorities when we're working towards a shared decision. But on the other side of things, clinicians need to be consistent in our application of guideline recommendations."

Of the 5689 statin-eligible patients in the analysis, 14% were African American and 86% were white. The proportions prescribed a statin were 70.61% and 74.85%, respectively (P = .02). The proportions to be prescribed statins at the guideline-recommended intensity were 33.3% for African Americans and 43.9% for whites (P < .001).