Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SoL) were published in the Journal of the American Heart Association.

“The underuse varied in this diverse ethnic group and was worse in people of Mexican background,” Simin Hua, MHSc, associate researcher in the department of epidemiology and population health at Albert Einstein College of Medicine, told Healio. “The need for medications did not seem to receive the same level of attention in patients with PAD as those with coronary artery disease even though both patient groups can benefit from these cardiovascular medications.”

Patients with PAD with, without CAD

Researchers analyzed data from 1,244 Hispanic/Latino patients who were either diagnosed with PAD by a physician (n = 826; mean age, 53 years; 59% women) or only had CAD (n = 418; mean age, 56 years; 42% women). Among the PAD cohort, 723 patients had PAD only (mean age, 53 years; 63% women) and 103 patients had both PAD and CAD (mean age, 56 years; 35% women).

The medication evaluation took into account 2005 American College of Cardiology/AHA guideline class I recommendations, which included antiplatelet therapy, lipid-lowering therapy and antihypertensive therapy for patients with hypertension. Researchers also assessed factors that may be associated with CV medication use including demographic characteristics, socioeconomic status, acculturation variables, number of doctor visits during the past year and health insurance coverage.

“Several studies have reported underuse of cardiovascular medications among individuals with peripheral artery disease,” Hua said in an interview. “However, Hispanic/Latino populations are underrepresented in large studies. Many U.S. Hispanic/Latino individuals face the issues such as lack of health insurance and high burden of cardiovascular risk factors. In addition, some studies suggested disparities in receiving care among this group. The cardiovascular medications we studied, including antiplatelet medications, statins and antihypertensive therapy, have been recommended in American College of Cardiology/American Heart Association guidelines to prevent adverse cardiovascular events and unfavorable outcomes among people with PAD.”

For patients with PAD, 31% took antiplatelet therapy and 26% took lipid-lowering therapy. Among patients with PAD and hypertension, 57% took antihypertensive medications. Mexican patients had the lowest prevalence of taking CV medications compared with Dominican, Central American, Cuban, South American and Puerto Rican patients.

In adjusted models, number of doctor visits, older age and existing hypertension and diabetes were significantly linked with taking CV therapies. 

Compared with patients with PAD alone, those with PAD and concurrent CAD were 1.52 times (95% CI, 1.2-1.93) more likely to take antiplatelet agents after adjusting for socioeconomic status, demographics, CV risk factors and health care access. According to the model, those with PAD and CAD were 1.74 times (95% CI, 1.3-2.32) more likely to take statin therapy than those with PAD alone. Differences were not observed for antihypertensive medication use in patients with PAD and CAD compared with those with PAD alone.

“The Hispanic/Latino population [has a] high burden of comorbidity of PAD such as diabetes, which is a risk factor for cardiovascular events in addition to PAD,” Hua told Healio. “Thus, heightened attention and more efforts are needed in the care of patients to prevent future cardiovascular events and leg amputation. We hope these findings, along with other studies, could provide evidence for further actions on improving treatment status and cardiovascular outcomes of PAD patients. Efforts in improving health care utilization and advocating for guideline-adherent treatment might be needed.”

Understanding underuse of medications

Hua added that more research is needed in this area. “Future in-depth research [is] needed, such as focus groups or in-depth interviews, to understand what could explain the low use of medications among individuals with PAD,” she said. “This might include examining whether reducing medication costs would help, since even for insured patients, out-of-pocket copayments may be a barrier in low-income populations. Another approach could be to ask whether patients need better education to understand that PAD, just like other diseases like heart attack which are more feared, can have serious consequences that can be prevented with treatment.”