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The patterns of statin use among midlife women

Francis, Jewel M (2016) The patterns of statin use among midlife women. Master Essay, University of Pittsburgh.

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Abstract

Background: In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) published recommendations for lipid management incorporating a new risk score for assessment of 10-year atherosclerotic cardiovascular disease, abbreviated as ASCVD scores. Statins are recommended for 4 specific groups of adults under the age of 75 years: 1) with vascular disease; 2) an LDL-C ≥ 190mg/dL; 3) with Diabetes Mellitus (DM) (and aged 40 - 75); and 4) with an ASCVD score ≥ 7.5%. Data on implementation of these recommendations among minority women are scarce. The purpose of this analysis was to examine racial differences in statin eligibility and use. Methods: Data from the Study of Women’s Health across the Nation (SWAN), a prospective, multiethnic cohort study of women, ages 42-52 at time of enrollment, and were used for the present analysis. Participants who contributed data at Visit 12 (2009- 2011) were included. Women were grouped into the four groups defined by the ACC/AHA lipid guidelines. Analysis was performed using Analysis of Variance (AOV), Chi-Square and logistic regression adjusting for age, BMI, site of study and education of the participants. Results: Of the 2399 women who were included, 234 had a cardiovascular disease diagnosis, 354 had Diabetes Mellitus (DM), 53 had an LDL-C ≥ 190 mg/dL and 174 had an ASCVD risk score ≥ 7.5%. Rates of statin use among those with elevated risk was low; 49.5% of those with CVD; 61.6% of those with DM, and 13.2% of those with LDL-C ≥ 190 mg/dL. Blacks and Hispanics had the lowest rates of statin use among these three risk groups. Only 24.7% of the women with an ASCVD score of ≥ 7.5% were on a statin. Blacks were more likely to have an ASCVD risk score ≥ 7.5% than Whites (OR=5.6, confidence interval [CI] 3.5-8.8). Of statin eligible women, 18.8% of the Black women were on a statin compared to 36.4% of the White women. Though not statistically significant, Blacks were less likely to be on a statin (OR=0.57, 95% CI 0.21-1.39) compared to Whites. Conclusion: Among a large, multiethnic cohort of midlife women, women in the four groups recommended for statin therapy by the current AHA guidelines, have low rates of statin use. Rates of statin use were low across all race/ethnic groups. Minority women, in particular, Blacks were more likely to fall into one of the four groups recommended for statin use. Public health significance: One out of every six deaths in the United States is due to coronary heart disease. Eating habits and other lifestyle factors play a key role in causing heart disease. The approach for primary prevention of cardiovascular events depends on assessing the risk using various scores. Our results indicate that risk assessment using the 2013 ACC/AHA guidelines for estimating 10-year atherosclerotic cardiovascular disease risk, could lead to lower rates of cardiovascular events. Accurate identification of such people allows healthcare professionals, policymakers and others to target prevention and treatment to those at the highest risk of morbidity and mortality.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Francis, Jewel Mjmf171@pitt.eduJMF171
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairEvans, Rhobert/Wrwe2@pitt.eduRWE2UNSPECIFIED
Committee MemberRuppert, Kristineruppertk@pitt.eduRUPPERTKUNSPECIFIED
Committee MemberDemirci, F. Yesimfyd1@pitt.eduFYD1UNSPECIFIED
Date: 26 April 2016
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 07 Sep 2016 17:54
Last Modified: 30 Oct 2018 14:01
URI: http://d-scholarship.pitt.edu/id/eprint/27379

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