# Disparities in statin use in patients with ASCVD with vs without rheumatologic diseases in a large integrated healthcare system: Houston methodist CVD learning health system registry

## TL;DR

This study finds that patients with both rheumatologic diseases and heart disease are less likely to receive statins, a key heart medication, compared to those without rheumatologic diseases.

## Contribution

The study identifies disparities in statin use among patients with atherosclerotic cardiovascular disease and comorbid rheumatologic diseases in a large US healthcare system.

## Key findings

- Patients with ASCVD and rheumatologic diseases had lower statin prescription rates (63.2%) compared to those without (71.7%).
- High-intensity statin use was also lower in patients with rheumatologic diseases (30.4%) versus those without (38.2%).
- Women were consistently less likely to receive high-intensity statins in both rheumatologic and non-rheumatologic groups.

## Abstract

The comorbid presence of Rheumatologic Diseases (RDs) and Atherosclerotic Cardiovascular Disease (ASCVD) substantially accentuates cardiovascular risk. We aimed to compare rates of secondary prevention statin utilization in patients with established ASCVD both with and without underlying comorbid RDs– and to highlight any potential gender, racial, or ethnic disparities in statin use in a contemporary US cohort.

We queried the electronic medical record (EHR)-linked Houston Methodist Learning Health System Outpatient Registry containing data for approximately 1.2 million patients to identify patients with diagnosed ASCVD and RDs using ICD-10 codes. Statin prescription rates and dosage were evaluated via ATC codes.

Among 113,021 patients with ASCVD, 7286 (6.4 %) had comorbid RDs. The majority (71.1 %) of patients with ASCVD were prescribed statins, with discernibly lower utilization in patients with comorbid RDs compared to the non-RD population (63.2 % vs. 71.7 %, p < 0.005). High-intensity statins were prescribed in 42,636 (37.7 %) of ASCVD patients, with similarly reduced utilization in RD vs non-RD patients (30.4 % vs. 38.2 %). These trends remained consistent across sociodemographic subgroups. Moreover, women were consistently less likely to receive high intensity statins in both RD and non-RD groups. Reduced statin utilization was not accounted for with non-statin lipid lowering therapies in RD vs non RD subgroups.

In this real-world study, co-morbid RDs were associated with significant lower utilization of secondary prevention statin therapy in patients with ASCVD. A multidisciplinary team approach may help to better understand key drivers of statin uptake in this clinically vulnerable population.