Background: Few studies have evaluated utilization of ASCVD-preventive therapies, such as statins, among PLWH. Although disparities by race, sex, and insurance status in statin utilization exist in the general population, the extent to which these disparities exist among PLWH - a population with a distinct demographic and risk factor profile - is unknown.
Methods: We compared statin utilization rates by race for the 3252 black and white PLWH in HIVE-4CVD who received care at Northwestern Medicine between 1/1/2000 and 5/17/2017. Persons were considered as having an indication for statin therapy if they had one or more of the following: (1) diabetes mellitus; (2) coronary heart disease; (3) a total cholesterol level of ≥240 mg/dL; and/or (4) calculated 10-year ASCVD risk of ≥7.5%. We compared statin utilization between black and white PLWH overall and stratified by insurance status. Multivariable-adjusted logistic regression adjusted for age, sex, and insurance status then was used to compare statin utilization for black vs. white PLWH with statin indications.
Results: Of 1680 white PLWH and 1572 black PLWH, 610 whites (36.3%) and 508 blacks (32.3%) had at least one indication for statin therapy. Among PLWH with statin indications, whites were significantly more likely than blacks to be taking statins (60.0% vs. 42.1%, p<0.001; Figure 1). This pattern persisted when analyses were stratified by insurance status. After adjustment for age, sex, and insurance status, black PLWH with statin indications were significantly less likely than their white counterparts to be taking statins (Odds ratio for blacks vs. whites = 0.56 , 95% CI 0.46-0.68, p<0.001).
Conclusions: Among PLWH with indications for statin use, blacks were significantly less likely than whites to be taking statins, even after adjustment for age, sex, and insurance status. Further studies of real-world statin use among PLWH are needed to understand reasons for disparities.