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Permanent URI for this communityhttps://hdl.handle.net/20.500.12503/32537
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Browsing Abstracts by Author "Aguiniga, Ashlyn"
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Item Right on Target? Analysis of LDL Levels and Medication Use in a Very High-Risk ASCVD Population(2024-03-21) Xavier, Christy; Aguiniga, AshlynPurpose: The American College of Cardiology (ACC) released an expert consensus pathway in 2022, introducing a new low-density lipoprotein (LDL) goal < 55 for very high-risk individuals with atherosclerotic vascular disease (ASCVD) and highlighting the need for additional non-statin therapies to achieve that goal and reduce the risk of recurrent cardiovascular (CV) events, hospitalization, and death. This study seeks to investigate whether this LDL target is being achieved and the antihyperlipidemic medications used in a very high-risk ASCVD primary care population at the UNTHSC Family Medicine Clinic. Methods: This is a retrospective chart review using the NextGen electronic record to evaluate patients at the UNTHSC Family Medicine Clinic. Living adults with very high-risk ASCVD were included. Very high-risk was defined as multiple major ASCVD events (myocardial infarction [I25.2, I22] or stroke [I63, Z86.73]) or one major ASCVD event and multiple high-risk conditions (heart failure [I50], diabetes [E10-E13], hypertension [I10-16], chronic kidney disease [N18], age > 65 years old, and current tobacco use). Demographics such as gender, race/ethnicity, insurance, and medications were also collected. Very high-risk ASCVD patients were then stratified based on LDL goal achievement and analyzed using Chi-square analysis, independent sample T-test, and descriptive statistics using SPSS. Results: Of the identified very high-risk ASCVD patients (n = 199), 60 (30.2%) had achieved an LDL goal < 55 mg/dL. The average LDL achieved in this group was 44.2 + 10.8 mg/dL vs. 98.6 + 44.0 mg/dL for non-achievers. All those who achieved an LDL goal < 55 mg/dL were on at least one antihyperlipidemic medication. Of those who achieved an LDL goal < 55 mg/dL, 49 (81.7%) were on a high-intensity statin, 8 (13.33%) were on ezetimibe, 6 (10%) were on fish oil, and 3 (5%) were on a PCSK9 inhibitor. No patients were prescribed bempedoic acid or inclisirin. For non-achievers, 81 (58.2%) were on a high-intensity statin, 10 (7.2%) were on ezetimibe, 14 (10.1%) were on fish oil, and only one (0.72%) patient was on a PCSK9 inhibitor. Twenty (14.4%) of the non-achievers were not on any antihyperlipidemic agents. This subset of patients had a much higher average LDL (108.1 + 33.3 mg/dL), and 20% had a history of multiple ASCVD events. LDL goal achievers were slightly older (average age 68.2 + 9.9 years vs. 65.5 + 10.5 years), male (60% vs. 33.6%), and commercially insured compared to non-achievers. Conclusions: A majority of very high-risk ASCVD patients at the UNTHSC Family Medicine Clinic are not currently achieving the LDL goal < 55 mg/dL. Additionally, non-statin therapies are not being widely used to augment statin therapy. Further investigation is needed to determine potential barriers and limitations to achieving this lower LDL target.Item Weighing Inequities: The Role of Obesity, Social Determinants of Health, with Glucagon-like Peptide-1 Receptor Agonist Use in Adults with Type 2 Diabetes in the United States(2024-03-21) Collins, Dallas; Kelly, Brittany; Aguiniga, Ashlyn; Pinnamraju, Jahnavi; Sambamoorthi, UshaTitle Weighing Inequities: The Role of Obesity, Social Determinants of Health, with Glucagon-like Peptide-1 Receptor Agonist Use in Adults with Type 2 Diabetes in the United States Authors Dallas Collins, Brittany Kelly, Ashlyn Aguiniga, Jahnavi Pinnamraju, Usha Sambamoorthi Abstract Background Glucagon-like peptide-1 receptor agonists (GLP-1) contribute to glycemic control and weight loss in patients with type 2 diabetes mellitus (T2DM). Although obesity is an important determinant of GLP-1 use, research studies have suggested racial, ethnic, and socioeconomic inequities in GLP-1 use may also exist. The purpose of this study is to determine associations of obesity and social determinants of health (SDOH) with GLP-1 use in a large, nationally representative sample of US households. Methods This is a cross-sectional analysis of adults (age > 18 years) with T2DM using pooled data from multiple years of the Medical Expenditure Panel Survey (2016, 2018, and 2020). The MEPS is a nationally representative survey of civilian non-institutionalized households in the US. Diabetes was identified from both medical conditions and household files. GLP-1 use was extracted from prescription drug event files using the multum classification therapeutic sub-sub class codes. Obesity was measured using body mass index categories using the CDC standards. We restricted our analysis to adults without missing data on body mass index. Rao-Scott chi-square tests were used to assess the unadjusted associations of categorical variables with GLP-1 use. Multivariable logistic regression with survey weights was conducted to analyze the association of obesity and SDOH variables (education, poverty, health insurance, metro area, and marital status) after controlling for gender, age, and health conditions. All analyses were conducted with SAS 9.4 survey procedures. Results There were 7,298 participants representing ~27.3 million US adults with T2DM. Overall, 7.7% of adults reported using GLP-1 and 55.2% had obesity. A higher percentage of obese adults reported GLP-1 use compared to normal and underweight adults (10.2% vs. 4.2%). Those with college education had higher rates of GLP-1 use compared to those with less than high school education (10.2 vs. 4.0%). Multivariable fully adjusted logistic regression confirmed that obesity was associated with higher odds of GLP-1 use (AOR=2.44, 95% CI= 1.58-3.76 p < 0.001) and lower less than high school (AOR=0.40, 95% CI=0.25-0.62 p <0.001) and high school education (AOR=0.72, 95% CI= 0.52-0.99, p=0.0434) were associated with lower odds of GLP-1 use. Conclusion Approximately one in 14 adults used GLP-1, with obesity being an important correlate. Our study findings suggest that socioeconomic status may act as a barrier to a medication with established benefits and may contribute to exasperating inequalities in diabetes care leading to disparities in health outcomes of adults with diabetes. Cohort studies may be needed to better understand the association of SDOH with GLP-1 use.