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Introduction:The burden of ASCVD is higher among non-Hispanic Black (NHB) and Hispanic vs. non-Hispanic White (NHW) US adults, potentially due to differences in use of preventive medications such as statins. We evaluated patterns in statin use for primary prevention by self-identified race/ethnicity (NHB, NHW, and Hispanic) according to 10-year ASCVD risk using the Pooled Cohort Equations.Methods:This serial, cross-sectional analysis included NHANES participants from 2013-2020 age 40-75 years without ASCVD, diabetes, LDL ≥190 mg/dL, or missing data for estimation of 10-year ASCVD risk. Statin use was determined by interviewer pill bottle review. Poisson regression estimated adjusted prevalence ratios for statin use associated with race/ethnicity and ASCVD risk categories (5-<7.5%, 7.5-<20%, and ≥20%); all analyses incorporated NHANES survey weights.Results:A total of 3,088 participants representing 37.8 million US adults (mean age 62 y, 38% women, 13% NHB, 11% Hispanic, 76% NHW) were included. Overall, statin use was lower in NHB (20.0%) and Hispanic (15.4%) than NHW adults (27.9%). Within all ASCVD risk categories, the odds of statin use were significantly lower among NHB and Hispanic vs. NHW adults (Figure). Within each race/ethnicity group, the use of statins increased across increasing ASCVD risk strata, with a significantly greater utilization among those with ASCVD risk ≥20% (vs. ASCVD risk 5-<7.5%) (Figure). Statin use was stable over time and within race/ethnicity and risk strata (p>0.05 for all NHANES cycles).Conclusions:Overall statin use for primary prevention based on 10-year ASCVD risk was low in all race/ethnicity groups regardless of predicted ASCVD risk, though undertreatment was most severe in NHB and Hispanic adults. Improvements in equitable utilization of statins for primary prevention in Black and Hispanic adults are needed to address disparities in ASCVD.

Background:Socioeconomic (SE) disadvantage is a strong determinant of adverse outcomes in patients with HF. The contribution of SE disparities to adverse outcomes in HF may differ among Black vs. White patients and has not been well studied.Methods:Using the 100% CMS MedPAR data, Black and White patients hospitalized with HF between 2014 and 2017 were identified and stratified based on the distressed community index (DCI)—a measure of the SE disadvantage of residential ZIP codes on a continuous scale (range 0-100, see Fig. legend)—into two groups: SE distressed (Q5) vs. non-distressed (Q1-4). The rates of 30-day and 1-year mortality and readmission were compared across the distressed vs. non-distressed race groups. The adjusted association between DCI and risk of adverse outcomes was assessed separately across the race groups using adjusted hierarchical logistic regression models with restricted cubic splines.Results:The study included 1,238,537 White (14.8% distressed) and 190,721 Black (44.4% distressed) patients. White patients living in SE distressed communities had a significantly higher risk of adverse outcomes at 30-days and 1-year f/u (Fig. A). In contrast, among Black patients, the risk of adverse outcomes among those living in distressed vs. non-distressed communities were not meaningfully different at 30-days and became more prominent by 1-year f/u. Similar results were noted in the restricted cubic spline analysis with stronger and more graded association between DCI score and risk of adverse outcomes in White (vs. Black) patients (Fig. B).Conclusion:SE distress is strongly associated with risk of adverse outcomes in White patients with HF. Among Black patients, SE distress is more common, but its adverse effects are less evident during short-term f/u and are better highlighted in the long-term. Other societal factors such as structural racism and poor access to care may be important prognostic determinants in Black patients with HF.

Background:Low socioeconomic status (SES) is associated with atherosclerotic cardiovascular disease (ASCVD) and possible underestimation of risk by the pooled cohort equations (PCE). Whether coronary artery calcium (CAC) scores can improve risk discrimination in those with low SES is unknown.Methods:Individuals from the Dallas Heart Study free of ASCVD and with CAC scanning were evaluated. Low SES was defined as an annual income <$16,000 or an educational attainment level ≤11 years. Unadjusted and adjusted analyses assessing the relationships between SES and 1) CAC scores and 2) ASCVD events (fatal or non-fatal MI or stroke) were performed. The incremental predictive value of CAC in those at low and higher SES was assessed using c-statistics (PCE alone vs PCE + CAC).Results:Among 2246 individuals (mean age 44 yrs, 55% women, 45% Black), 115 ASCVD events occurred over a median of 12.5 years. Low SES by income (n=451) was associated with increased risk of ASCVD after adjustment for risk factors (HR 2.16, 95% CI 1.37-3.42), but was not independently associated with CAC. Higher CAC scores (0, 1-99, ≥100) tracked with increased 10-year ASCVD event rates in those at low (5, 10, and 22%) and higher SES (0.002, 4, and 11%), with low SES groups carrying greater ASCVD risk for every stratum of CAC, including with CAC=0. In multivariable models compared with CAC=0, those with CAC 1-99 and ≥100 had a greater risk of ASCVD events for individuals at higher SES [HR 3.40 (1.5-7.8), and 4.8 (1.9-12.6)], but not for those with low SES [HR 1.00 (0.4-2.4), and 1.6 (0.6-4.6)], (p-interaction CAC x SES=0.002). Similar results were found for low SES defined by education. The addition of CAC to PCE improved risk discrimination for individuals at higher SES, but not for individuals at low SES (Table 1).Conclusion:Individuals at low SES have significantly increased risk of ASCVD, however, CAC scores are not independently associated with ASCVD in this population and may be less useful in risk discrimination.

Introduction:Prior studies have reported improvements in population-level risk factor burden and cardiovascular outcomes using polypill strategy. We aimed to provide an updated meta-analysis of RCTs evaluating the efficacy of polypill-based strategy in reducing the risk of adverse cardiovascular outcomes.Methods:RCTs examining the association between polypill therapy and cardiovascular outcomes published before 2/1/2021 were included. The outcomes of interest were major adverse cardiovascular events (MACE) and all-cause mortality. Risk ratios for dichotomous outcomes were converted to log RR and pooled using a generic inverse variance weighted random-effects model. Data for continuous outcomes were pooled using random-effects modeling and presented as mean differences with 95% CIs.Results:Eight studies representing 25,584 patients were included for analysis. In pooled analysis, the use of polypills was associated with a non-significant reduction in the risk of MACE [RR(95% CI): 0.85(0.70-1.02)] and significant reductions in the risk of all-cause mortality [RR(95% CI): 0.90(0.81-1.00)]. The reductions in the risk of MACE with polypill use varied by baseline risk and nature of the study population [primary prevention (polypill, 476/10503; control, 684/10509) vs. secondary prevention (polypill, 170/2307; control, 153/2265)], with the most significant risk reduction among lower-risk cohorts, including within primary prevention populations [RR 0.70 (0.62, 0.79)]. Among CV risk factors, modest but significant reductions were observed for systolic and diastolic blood pressure, but not for levels of total or LDL-cholesterol. Polypill strategy was also associated with significantly improved drug adherence [RR(95% CI): 1.31(1.11-1.55)].Conclusions:. Polypill strategy is associated with significant reductions in cardiovascular risk factors and the risk of all-cause mortality and MACE, particularly in the primary prevention population.