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Retrospective Evaluation of ASCVD Risk and Statin Therapy Need in Nondiabetic Patients Based on the 2013 ACC/AHA
Carrie Koenigsfeld1, Morgan Sayler2,3, Hayden L Smith4,5
11 Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, Des Moines, IA, USA.
Insights
The 2013 ACC/AHA Cholesterol Guidelines may increase statin prescribing. Pharmacists can identify and manage patients needing statin therapy in the fourth benefit group, improving cardiovascular disease prevention.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- The 2013 American College of Cardiology and American Heart Association (ACC/AHA) Cholesterol Guidelines introduced new criteria for statin therapy.
- The fourth statin benefit group includes individuals aged 40-75 without diabetes or clinical atherosclerotic cardiovascular disease (ASCVD), but with an ASCVD score ≥7.5%.
Purpose of the Study:
- To evaluate the impact of the 2013 ACC/AHA Cholesterol Guidelines on identifying patients eligible for statin therapy within the fourth benefit group.
- To assess the potential role of pharmacists in managing these patients.
Main Methods:
- Retrospective analysis of electronic health records for patients with lipid panels within 12 months prior to November 1, 2013.
- Inclusion of 3203 patients after excluding those with uncalculable 10-year ASCVD risk.
Main Results:
- Among 2008 patients not on statin therapy, 25% (501) had an ASCVD score ≥7.5%.
- Factors associated with increased ASCVD risk included older age, smoking, male sex, and hypertension treatment.
- 23.2% (466) of non-statin patients met criteria for initiating moderate- or high-intensity statin therapy.
Conclusions:
- The 2013 ACC/AHA guidelines are expected to increase statin prescribing rates.
- Screening strategies are crucial for identifying eligible patients in this group.
- Pharmacists are well-positioned to screen patients, educate them on statin therapy, and monitor adherence.
Purpose:
Study goal was to assess the impact of the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) Cholesterol Guidelines on patients in the fourth statin benefit group which included patients aged 40 to 75 years, without diabetes or clinical atherosclerotic cardiovascular disease (ASCVD), and have an ASCVD score ≥7.5%. These patients could benefit from treatment interventions by a pharmacist.
Methods:
Patients were identified from electronic health records. A sample of 3503 patients was ascertained from having a lipid panel performed within the 12 months before November 1, 2013. Patients were excluded if we were unable to calculate 10-year ASCVD risk.
Results:
A total of 3203 patients were included, with 2008 not on statin therapy. Of those, 1507 (75%) had a 10-year ASCVD risk score <7.5% and 501 (25%) had a score > 7.5%. Patient characteristics leading to an increase in risk included advanced age, smoker, male, and hypertension treatment. Of 2008 nonstatin patients, there were 466 (23.2%) who fit criteria for initiation of moderate- or high-intensity statin.
Conclusion:
Widespread adoption of the 2013 ACC/AHA Cholesterol Guidelines will expand prescribing rates of statins. Implementing screening strategies may help identify patients who require treatment in this fourth statin benefit group. A pharmacist can be vital in screening patients, educating patients regarding the need for medication therapy, and monitoring for adherence in these new regimens.
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