Abstract 4124606: Disparities in statin use following identification of Coronary Artery Calcium

Introduction: Coronary artery calcium (CAC) scoring is a useful tool for risk stratification in asymptomatic individuals, and guidelines recommend statin use in individuals with CAC. A growing body of research has aimed to identify and mitigate health disparities and their relation to CVD risk. Likewise, studies have highlighted social determinants of health (SDOH) that contribute to health disparities in CVD. We sought to extend this work by evaluating whether disparities exist with regards to statin use after identification of CAC within the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: The sample consisted of all MESA participants with baseline CAC >0, not already on statin therapy, and without prior CVD events (n=2665). The association between race/ethnicity, age, sex, primary language, and an aggregate SDOH score with statin prescription at short (exam 2, median 1.6 year) and long (exam 5, median 9.4 year) term follow-up was evaluated in logistic regression models with adjustment for traditional CVD risk factors. The SDOH score was created from 14 components which covered the 5 general domains described in the Healthy People 2030 initiative (Figure 1). Results: Rates of statin prescription after CAC identification by race/ethnicity, language, and SDOH score tertile are shown in Figure 2. At short-term follow up, those with a higher SDOH score (worse burden) (OR 0.39, 95% CI 0.16-0.91), Hispanic / Latino participants (OR 0.59, 95% CI 0.40-0.85) and Spanish speaking participants (OR 0.51, 95% CI 0.30-0.83) were less likely to report statin use following CAC identification. At long-term follow up, Black participants (OR 0.71, 95% CI 0.52-0.96), Chinese participants (OR 0.58, 95% CI 0.39-0.86) and Chinese speaking participants (OR 0.50, 95% CI 0.33-0.76) were also less likely to report statin use following CAC identification, and a trend was noted for SDOH score (OR 0.53, 95% CI 0.26-1.09). Conclusion: This study identifies disparities in statin use after identification of CAC by race/ethnicity, language and social determinants of health. Future studies should investigate underlying reasons for these disparities and potential interventions to reduce disparities in cardiovascular care.