Quantifying sociodemographic and income disparities in medical therapy and lifestyle among symptomatic patients with suspected coronary artery disease: a cross-sectional study in North America

Abstract

Objectives: To evaluate potential gaps in preventive medical therapy and healthy lifestyle practices among symptomatic patients with suspected coronary artery disease (CAD) seeing primary care physicians and cardiologists and how gaps vary by sociodemographic characteristics and baseline cardiovascular risk.

Design: Cross-sectional study assessing potential preventive gaps.

Participants: 10 003 symptomatic outpatients evaluated by primary care physicians, cardiologists or other specialists for suspected CAD.

Setting: PROspective Multicenter Imaging Study for Evaluation of Chest Painfrom 2010 to 2014.

Measures: Primary measures were absence of an antihypertensive, statin or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for renal protection in patients with hypertension, dyslipidaemia or diabetes, respectively, and being sedentary, smoking or being obese.

Results: Preventive treatment gaps affected 14% of patients with hypertension, 36% of patients with dyslipidaemia and 32% of patients with diabetes. Overall, 49% of patients were sedentary, 18% currently smoked and 48% were obese. Women were significantly more likely to not take a statin for dyslipidaemia and to be sedentary. Patients with lower socioeconomic status were also significantly more likely to not take a statin. Compared with Whites, Blacks were significantly more likely to be obese, while Asians were less likely to smoke or be obese. High-risk patients sometimes experienced larger preventive care gaps than low-risk patients. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event (HR 1.35, 95% CI 1.02 to 1.82).

Conclusions: Among contemporary, symptomatic patients with suspected CAD, significant gaps exist in preventive care and lifestyle practices, and high-risk patients sometimes had larger gaps. Differences by sex, age, race/ethnicity, socioeconomic status and geography are modest but contribute to disparities and have implications for improving opulation health. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event.

Clinical trial registration: Clinical Trials.gov identifier NCT01174550.

Keywords: cardiac stress testing; coronary artery disease; coronary computed tomography angiography; health disparities; socioeconomics.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1

Preventive medical therapy and lifestyle practices at presentation, by sex, age and race/ethnicity. The bars represent covariate-adjusted probabilities of a preventive care gap, based on the multivariate models reported in table 2. The reference groups for tests of statistical significance are male sex, 45–64 years old and White race/ethnicity. ACEi/ARB, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. We assessed antihypertensive use in hypertensives, statin use in dyslipidemics, and ACEi/ARB in diabetics. *P

Figure 2

Preventive medical therapy and lifestyle practices at presentation. The bars represent covariate-adjusted probabilities of a preventive care gap, based on the multivariate models reported in table 2. The reference groups for tests of statistical significance are high socioeconomic status and South region. ACEi/ARB, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. We assessed antihypertensive use in hypertensives, statin use in dyslipidemics, and ACEi/ARB in diabetics.*P