Cardiovascular medications underused in Hispanic/Latino patients with PAD
Efforts to improve peripheral artery disease (PAD) treatment in Hispanic/Latino populations are needed, including improved access to health care and more guideline-adherent treatment, according to the authors of a recent study.
Recommended medications for peripheral artery disease (PAD) and coronary artery disease (CAD) are underused among Hispanic and Latino patients, researchers reported.
Researchers studied the use of cardiovascular therapies among participants in the Hispanic Community Health Study/Study of Latinos, comprising 1,244 Hispanic/Latino individuals ages 18 to 74 from Chicago, Miami, San Diego, and the Bronx. The study is an ongoing, community-based, prospective study to estimate rates of cardiovascular disease and associated risk factors among the U.S. Hispanic/Latino populations, including Dominican, Cuban, Central American, Mexican, Puerto Rican, and South American.
The study compared use of antiplatelet therapy, lipid-lowering therapy, and antihypertensive therapy by PAD and CAD status. Among those with PAD, researchers studied factors associated with taking cardiovascular medications, including demographic and socioeconomic factors, acculturation, access to health care, and comorbidities, using multivariable regression models. Results were published by the Journal of the American Heart Association on Aug. 5.
During an in-person interview and health exam conducted in English and Spanish, 826 patients self-reported a diagnosis of PAD (723 without concurrent CAD and 103 with concurrent CAD). The remaining 418 participants self-reported only CAD. Participants were instructed to bring to the appointment the medications they had taken within the past month.
Almost half of the individuals diagnosed with PAD did not have a high school degree and 70% had an annual household income less than $30,000. More than 60% had two or more cardiovascular risk factors, including obesity, hypertension, dyslipidemia, and diabetes, and 27% were current smokers. Compared to patients with only PAD, those with both PAD and CAD were older and more likely to be male, be retired, have less than a high school education, have health insurance coverage (especially Medicaid or Medicare), and take more medications. They also had worse cardiovascular risk factors, more comorbidities such as diabetes, stroke, and heart failure, and more intermittent claudication. Participants with CAD alone resembled those with concurrent PAD and CAD in age, health insurance coverage, health care use, and cardiovascular risk factors.
Among patients with PAD, 31% were taking antiplatelet therapy, 26% were on lipid-lowering therapy, and 57% of hypertensive patients were on antihypertensive therapy. Patients of Mexican descent had the lowest use of all classes of cardiovascular medications. Older age, higher number of doctor visits, and existing hypertension and diabetes were significantly associated with taking cardiovascular therapies in adjusted models. Compared with those with PAD alone, individuals with PAD and CAD were 1.52 (95% CI, 1.20 to 1.93) and 1.74 (95% CI, 1.30 to 2.32) times more likely to use antiplatelet agents and statins. There were no significant difference in antihypertensive medication use by whether PAD patients also had CAD.
Researchers noted several limitations. The study did not include any non-Hispanic or non-Latino patients for comparison. It also did not include information about medication use over time, or whether participants were not prescribed medications or were not adhering to prescriptions. In addition, study participants could have inaccurately reported their PAD diagnosis.
The authors noted that the majority of the study population was born outside of the United States, most preferred to speak Spanish, and about 37% did not have health insurance coverage. These factors may be associated with low use of prescribed medications among Hispanic/Latinos in the United States. Compared with other groups, Hispanic/Latino patients with PAD are more likely to be admitted to EDs with higher disease severity and are less likely to have lower-extremity revascularization when hospitalized despite ischemic conditions, the study authors observed.
“Our results suggest that improving healthcare use and advocating for guideline-adherent treatment, especially among those with PAD alone, might be key factors to increasing cardiovascular medication use,” the authors wrote.