Frequency of Guideline-Based Statin Therapy in Adults With Congenital Heart Disease

Area of Science:

• Cardiology
• Preventive Medicine
• Public Health

Background:

• Adult congenital heart disease (ACHD) requires ongoing cardiovascular risk assessment.
• Primary prevention of atherosclerotic cardiovascular disease (ASCVD) is crucial in all adult populations.
• Guideline-based statin therapy is a cornerstone of primary ASCVD prevention.

Purpose of the Study:

• To evaluate atherosclerotic cardiovascular disease (ASCVD) risk estimates in adults with congenital heart disease (ACHD).
• To assess guideline-based statin use for primary prevention of ASCVD in ACHD patients.
• To compare ASCVD risk and statin prescribing patterns between ACHD cases and matched controls.

Main Methods:

• Retrospective, case-controlled study comparing 248 ACHD cases with 744 age- and gender-matched controls.
• Calculation of 10-year ASCVD risk scores using the 2013 ACC/AHA guidelines.
• Assessment of statin therapy indication and prescription for primary ASCVD prevention.

Main Results:

• No significant difference in average 10-year ASCVD risk scores between ACHD cases (4.6%) and controls (5.1%).
• ACHD cases showed lower total cholesterol and smoking rates, but higher hypertension rates and lower HDL cholesterol.
• Only 42.3% of ACHD cases with a statin indication received appropriate therapy, compared to 59.0% of controls (p=0.04).

Conclusions:

• Adults with congenital heart disease (ACHD) have comparable atherosclerotic cardiovascular disease (ASCVD) risk to their peers.
• ACHD patients are significantly less likely to be prescribed statin therapy for primary ASCVD prevention, despite guideline indications.
• This disparity highlights a potential gap in preventive cardiovascular care for the ACHD population.