Mistrust, Bias May Cause Disparities in Cholesterol-Lowering Medication Use

By: Ava Dzurenda

Minoritized adults are not receiving cholesterol-lowering medications at the same rate as their white counterparts, and this disparity cannot be explained by measurable factors like access to resources or disease severity, according to new research conducted by scientists at the University of Pittsburgh School of Medicine, published today in Annals of Internal Medicine. Instead, the researchers posit that societal influences, such as bias, stigma and distrust, may be to blame.

In patients with atherosclerotic cardiovascular disease (ASCVD), plaque builds up in their blood vessels reducing blood and oxygen in their body, potentially leading to a stroke or a heart attack. Cholesterol-lowering drugs called statins work to prevent these events. Yet, despite their efficacy and widespread availability, many patients are not prescribed statins.

“Statins are considered the standard of care for patients with ASCVD, and the guidelines for prescribing this medication are longstanding,” said Ravy Vajravelu, M.D., assistant professor of medicine at Pitt. “Approximately 30% of adults ages 21 through 75 are eligible for statins, but many do not receive them or are prescribed other medications that are not as effective. We wanted to determine why certain populations aren’t receiving this life-saving drug despite these clear guidelines.”

Dr. Ravy Vajravelu

Vajravelu and colleagues used data from the Centers for Disease Control and Prevention’s National Health and Examination Survey to determine the differences in statin use by eligible patients categorized by race and gender. The researchers then used the National Academy of Medicine framework for identifying disparities in treatment between these groups. The researchers accounted for structural disadvantages, such as education, access to health care and socioeconomic status.

The analysis found that, among at-risk adults seeking medication for preventing ASCVD, Black men and Hispanic women were less likely to use statins than white men. However, no measurable structural influences — such as health insurance coverage, formal education and socioeconomic status —explain the differences. The study also demonstrated disparities among adults with ASCVD eligible for statins to prevent heart attacks and strokes.

“Our results show that disparities in statin use are linked to care-process factors, such as bias, stereotyping and mistrust,” Vajravelu said. “This underscores the need for providers to improve equity and reduce conscious and unconscious bias in their practices.”

While this study focused on one drug class, Vajravelu hopes this kind of research will be expanded to help reduce disparities in prescribing other drugs in minority populations.

“This study is important, especially for providers,” said Vajravelu. “With awareness about the bias, stereotyping and mistrust, we can work to create a health care system that treats all patients with equity.”

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