Jiang Bian, PhD, and Yi Guo, PhD, on Statin Use Among the Lesbian, Gay, and Bisexual Populations
Lesbian, gay, and bisexual (LGB) adults may be less likely to take statins to prevent cardiovascular disease (CVD), according to the results of a recent study. This finding comes despite this patient population being at an increased risk of cardiovascular events due to higher rates of health risk factors.
The researchers examined the associations of statin use in LGB populations, as evidence has previously suggested that prescribing statins as a primary prevention may reduce CVD risk. Included in the cross-sectional cohort study were 1531 adults aged 40 years or older who responded to a Facebook advertising campaign for the online survey.
The study revealed that only 20.9% of LGB respondents used statins, while 43.8% of non-LGB respondents did. In addition, the overall prevalence of statin use in the primary prevention population was 39.6%, while the prevalence among the secondary prevention population was 57.5%.
To discuss these findings further and examine their implications, Consultant360 reached out to two of the study authors, Jiang Bian, PhD, and Yi Guo, PhD. Jiang Bian is an associate professor and director of Cancer Informatics and EHealth Core at the University of Florida College of Medicine. Yi Guo, who is the first author of this study, is an assistant professor in the Department of Health Outcomes & Biomedical Informatics in the College of Medicine at the University of Florida.
Consultant360: Your study focused on the rate of statin use to prevent atherosclerotic CVD specifically among LGB populations, as these individuals have an increased risk of cardiovascular events. Could you discuss what prompted you and your team to examine this research question?
Jiang Bian & Yi Guo: Simply lack of research on CVD prevention in the LGBT (lesbian, gay, bisexual, and transgender) population. Our team has been studying the health outcomes of the LGBT population for many years now. We have expertise in identifying LGBT individuals in emerging health big data sources, such as social media and electronic health records (EHRs), and studying their health outcomes.
Our review of the medical literature revealed that the utilization of statin medications was never examined in LGBT individuals. Therefore, we decided to conduct a preliminary, social media-based survey study to calculate the rates of statin use population. However, in our study, we did not recruit sufficient number of transgender individuals; thus, our initial analysis focused on the LGB population.
C360: The results indicated that LGB participants were less likely than non-LGB participants to use statins for primary prevention of CVD. Is this a result that you anticipated, or did this surprise you?
JB & YG: We were not really surprised to see a lower rate of statin use in statin-eligible LGB individuals, as higher rates of many other risky health behaviors have been well-documented in this population. But we were surprised to see that the difference is this large (less than half of the rate in the non-LGB population). This highlights the urgent need for tailored interventions/campaigns that promote the awareness of statin use and cardiovascular health in the LGB population.
C360: The study notes that while LGB respondents had lower rates of statin use for primary prevention of CVD than non-LGB participants, the rates for secondary prevention of CVD are similar between the 2 groups What is the importance of this finding?
JB &YG: The observed difference indicates that many LGBT individuals are unaware of their elevated CVD risk or the preventive effects of statin medications. Once the CVD is diagnosed and they are aware of the risk, they are willing to follow the secondary prevention guidelines.
C360: How will the results of your study impact clinical practice?
JB & YG: 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. Care of the LGBT community is complex due to many factors, including less use of health care resources, increased complexity due to high-risk behaviors, bias on the part of providers, lack of understanding by the LGBT community as to their risk and the importance and benefit of treatment all require different interventions. Education of this patient population and urgent need to enhance the LGBT cultural competence of our health professionals is needed.
C360: What areas of research still need to be addressed among the sexual- and gender- minority populations.
JB & YG: Our study is limited in that it is based on a convenience sample and survey methodology. These results need to be replicated using clinical data from the real world, such as those in EHRs or administrative claims. Further analysis of EHRs will also reveal important factors, such as health care utilization, that can explain the differences in statin use between LGB vs non-LGB populations.
In general, most clinical studies on the LGBT population include small sample sizes, mostly due to the LGBT population’s unwillingness to reveal their identity and poor documentation of LGBT status in heath databases. For example, in our study, we did not recruit sufficient transgender individuals. Better ways and informatics tools for documenting LGBT status are needed.
Guo Y, Wheldon CW, Shao H, et al. Statin use for atherosclerotic cardiovascular disease prevention among sexual minority adults. Am Heart J. 2020;9(24). doi:10.1161/JAHA.120.018233