Residents in the Stroke Belt Less Likely to Be Prescribed Statins Following Stroke Hospitalization Discharge

Few patients who experience a stroke are prescribed a statin at the time of hospital discharge, despite evidence demonstrating statins’ ability to decrease the risk of a recurrent stroke. This is distinctly apparent among blacks who are disproportionately affected by strokes, suggesting racial disparities in statin prescribing.

A study recently published in the Journal of the American Heart Association utilized data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a trial of 30,239 US adults that investigated the factors associated with the excess stroke mortality among blacks in Stroke Belt states and compared them with whites and other geographic regions. The REGARDS study results were used to estimate the proportion of patients with ischemic stroke who receive a statin at discharge and to analyze the discharge stain prescribing among different ages, races, and sexes.

The researchers conducted telephone interviews, questionnaires, and an in-home examination in order to collect demographics and medical information, including the medication prescribed following a hospitalization, of all REGARDS participants that met the study criteria.

Of the 323 participants included in the analysis, 48.9% were black, 45.8% were men, and 55.7% resided in the Stroke Belt. Among Stroke Belt residents, those who were at least 65 years old were 47% less likely to be discharged on a statin compared with those younger than 65, which was a disparity not observed among populations outside of the Stroke Belt. Furthermore, male Stroke Belt residents were 31% less likely to be discharged on a statin when compared with females; in addition, among non-Stroke Belt residents, men were more likely to be discharged on a statin.

“By examining Stroke Belt residence as an effect modifier, we were able to examine the direction and magnitude of the age, sex, and race effect inside and outside of the Stroke Belt,” the researchers wrote. “In contrast to previous studies that have reported blacks as less likely to be prescribed statins we found no differences in discharge statin prescribing between blacks and whites. There were, however, statistically significant age and sex differences among Stroke Belt residents.”

Because the study found that men 65 years old and older were less likely to be discharged with a statin prescription, but did not find any evidence of racial disparities, future studies are necessary to evaluate statin adherence in ischemic stroke survivors to better understand the higher rate of recurrent strokes in blacks.