Lesbian, gay, and bisexual (LGB) adults are at higher risk for cardiovascular disease (CVD) compared with non-LGB individuals but are less likely to be treated with cholesterol-lowering medications, new research suggests.
Investigators at the University of Florida College of Medicine, Gainesville, conducted a Facebook-delivered online survey of over 1500 individuals aged 40 years or older regarding disease history, health status, statin use, and demographic information, including sexual orientation and gender identity.
They found that only 20% of LGB adults were taking statins for primary prevention of CVD compared with 43.8% of non-LGB respondents.
"The results offer some insight into the need for providers to examine the care of their LGBT population to ensure that guideline-directed therapy is recommended and prescribed," lead author Yi Guo, PhD, assistant professor in the Department of Health Outcomes and Biomedical Informatics, and senior author Jiang Bian, PhD, director of cancer informatics and associate professor, told Medscape Medical News in a coauthored email.
The study by Guo, Bian, and colleagues was published online December 2 in the Journal of the American Heart Association.
"Ideal Platform"
"Sexual gender minority [SGM] individuals…are at increased risk for CVD, due to elevated rates of health risk factors such as smoking," Guo and Bian said.
"However, although there is clear evidence that statin use can prevent CVD in certain adult populations, no studies have examined how statins are being used among the SGM population," they noted.
Previous research has suggested less than half of individuals in statin-eligible populations may be using them, but it is possible that among LGB populations, disparities exist because of "lower engagement in preventive services," the authors suggest.
The researchers therefore set out to "examine the prevalence and predictors of statin use among middle-aged and older LGB and non-LGB individuals" by conducting a cross-sectional online survey from September to December 2019, using Facebook advertising.
They chose Facebook because its use has increased "dramatically" over the last decade among older adults in the US, "making it an ideal platform for research targeting older adults."
Moreover, the Facebook ads facilitated "targeted advertising based on users' location, demographics, and other profile information."
Survey questions focused on sexual orientation, gender identity, statin use, general health status, chronic medical conditions, smoking status, and other demographic information (eg, race/ethnicity, education, and household income).
The ads yielded 1531 respondents (59.6% female [assigned at birth]; 90.6% non-Hispanic White). Most (80.1%) were between the ages of 40 and 75 years.
Of the overall cohort, most reported having "excellent/very good/good" physical or mental health (77.6% and 88.2%, respectively). Roughly one third of respondents had private health insurance, whereas a little over half were insured through Medicare (32.3% and 53.5%, respectively).
Of the respondents, 12.2% (n = 187) self-identified as LGB. Some salient differences between the LGB and non-LGB respondents are listed below.
| Characteristic | Non-LGB | LGB | P Value |
|---|---|---|---|
| > High school education | 84.4% | 91.8% | .012 |
| Excellent/very good/good physical health | 77.5% | 78.1% | .999 |
| < $50,000 household income | 40.6% | 53.6% | .006 |
| Current smoking | 14.5% | 21.6% | .021 |
| Excellent/very good/good mental health | 89.4% | 78.7% | < .001 |
| Medicaid insurance | 3.7% | 8.9% | .008 |
| Medicare insurance | 54.5% | 45.2% | .008 |
Lower Statin Use
Roughly one third of the overall cohort (31.6%) were currently taking statins. However, a considerably lower rate of statin use was reported by LGB than by non-LGB respondents (20.9% vs 33.1%, respectively, P < .001).
Although the overall prevalence of statin use rose with age (from 28% in those 40-75 years to 39% in those older than 75) in LGB as well as non-LGB respondents, the LGB respondents had significantly lower rate of statin use compared with their non-LGB counterparts (21.3% vs 31%, respectively, in each age group).
When looking specifically at the use of statins for primary prevention, the researchers found that 39.6% of all respondents were using statin drugs. However, there was a significantly lower rate of statin use in LGB vs non-LGB respondents (20.8% vs 43.8%; P <.001).
The pattern was similar when the researchers looked at each age group separately.
There was no statistical difference between the LGB and non-LGB respondents in statin use for primary prevention.
When the researchers adjusted for all covariates, they likewise found that LGB participants were less likely to use statin drugs, compared to both the overall (OR, 0.62 [95% CI, 0.41 - 0.94) and the primary prevention (OR, 0.37 [95% CI, 0.19 - 0.70)] populations.
"It has been indicated that health behaviors such as healthcare utilization play an important role in predicting statin use among statin-eligible individuals… However, LGB individuals are less likely than non-LGB individuals to have regular doctor visits, which has led to the lower prevalence of statin use in this population," the researchers write.
Use of healthcare resources, increased complexity due to high-risk behaviors, bias on the part of providers, a lack of understanding by the LGB community about their risk, and the importance and benefit of treatment all require different interventions, they noted.
The investigators also point out that consistent documentation of LGB-related issues in electronic health records will help generate "real-world" research data that advances clinicians' understanding of the health disparities in the LGB population.
Tailored Care
Commenting on the study for Medscape Medical News, Billy Caceres, PhD, RN, assistant professor at Columbia School of Nursing and Columbia University's Program for the Study of LGBT Health, New York City, said the findings "support the need for clinicians to better identify LGB patients at risk for suboptimal statin use."
However, he noted, given current practices across healthcare settings, it might be difficult to identify LGB patients because assessment of sexual orientation is not a common practice in healthcare settings.
Caceres, who was not involved with the study, noted that clinicians generally lack the appropriate training and skill set to "ask patients about their sexual orientation in a supportive and affirming manner."
The study findings, said Caceres, further highlight the importance of assessing a patient's sexual orientation as part of routine primary care to help clinicians identify those at highest risk for suboptimal statin use and subsequent cardiovascular events.
This is an important step in creating tailored screening for LGB adults at risk for CVD, he noted.
The study was funded in part by the Cancer Informatics Shared Resources of the University of Florida Health Cancer Center and the University of Florida Clinical and Translational Science Institute, which is supported in part by the NIH National Center for Advancing Translational Sciences. Additional funding was provided by the National Cancer Institute and the National Institute on Aging. The study authors and Caceres have disclosed no relevant financial relationships.
J Amer Heart Assoc. Published online December 9, 2020. Full text
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Cite this: 'Suboptimal' Primary CVD Prevention for Sexual Minorities - Medscape - Dec 09, 2020.
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