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Prevalence of Guideline-Directed Medical Therapy for Cardiovascular Disease Among Baltimore City Adults in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study

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Abstract

Objective

Guideline-directed medical therapy (GDMT) has been shown to improve outcomes for people with cardiovascular disease (CVD). Our goal was to assess racial and socioeconomic differences in GDMT use among a diverse population.

Methods

We examined the cross-sectional association of race and poverty status with GDMT among 441 participants with CVD in a longitudinal cohort of urban-dwelling Black and White adults in Baltimore City, Maryland, using multivariable logistic regression. CVD status and GDMT were self-reported.

Results

The participants’ mean age was 60.5 (SD 8.5) years, with 61.7% women, 64.4% Black, and 46.9% living below poverty. Of the 126 participants with coronary artery disease (CAD), 37.3%, 54.8%, and 62.7% were on aspirin, antiplatelets, and statins, respectively. Black participants with CAD were less likely to be on aspirin, OR 0.29 (95% CI 0.13–0.67), and on combination GDMT (antiplatelet and statin), OR 0.36 (0.16–0.78) compared to Whites. There were no differences by poverty status in GDMT for CAD. Fully, 222 participants reported atrial fibrillation (AF), but only 10.5% were on anticoagulation with no significant difference by race or poverty status. The use of GDMT for heart failure and stroke was also low overall, but there were no differences by race or poverty status.

Conclusions

Among an urban-dwelling population of adults, the use of secondary prevention of CVD was low, with lower aspirin and combination GDMT for Black participants with CAD. Efforts to improve GDMT use at the patient and provider levels may be needed to improve morbidity and mortality and reduce disparities in CVD.

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Data Availability

The study data will not be made available to other researchers for the purposes of reproducing the results or replicating the procedure because of human subjects’ restrictions.

Code Availability

The code is available for replication of the results.

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Funding

This work was supported in part by the Intramural Research Program of the National Institutes of Health (NIH), National Institute on Aging (A.B.Z and M.K.E). This work was also supported by Diversity Supplement under ARIC Contract Grant Number Contract HHSN268201700002I/ 75N92019F00074 from the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH) (L.M), the Johns Hopkins University President’s Frontier Award (D.C.C), and grant K24 HL148181 from the National Heart, Lung and Blood Institute, NIH (D.C.C). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Lena Mathews, Dingfen Han, Chiadi E. Ndumele & Deidra C. Crews

  2. Division of Cardiology, Johns Hopkins School of Medicine, 600 North Wolfe Street Blalock 524D, Baltimore, MD, USA

    Lena Mathews & Chiadi E. Ndumele

  3. Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD, USA

    Michele K. Evans & Alan B. Zonderman

  4. Johns Hopkins Center for Health Equity, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Chiadi E. Ndumele & Deidra C. Crews

Authors
  1. Lena Mathews
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Contributions

LM (design and concept of study, data analysis and interpretation, manuscript draft); DH (data analysis and interpretation, statistical expertise, manuscript draft, supervision); MKE (acquisition of data, manuscript draft, supervision); ABZ (acquisition of data, manuscript draft, supervision); CEN (manuscript draft), and DCC (design and concept of study, data analysis and interpretation, manuscript draft, supervision).

Corresponding author

Correspondence to Lena Mathews.

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Conflict of Interest

The authors declare no conflicts of interest.

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the National Institutes of Health and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the National Institute of Health.

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Informed consent was obtained from all participants included in the study.

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Mathews, L., Han, D., Evans, M.K. et al. Prevalence of Guideline-Directed Medical Therapy for Cardiovascular Disease Among Baltimore City Adults in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study. J. Racial and Ethnic Health Disparities 9, 538–545 (2022). https://doi.org/10.1007/s40615-021-00984-y

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