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Assessing Changes in Statin Prescribing Patterns Surrounding the 2013 American College of Cardiology/American Heart
Kimberly E Kelly1, Michael R Jiroutek2, Kimberly Lewis2
1Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA; Harnett Health System, Lillington, NC, USA.
Insights
New 2013 guidelines led to more adults being prescribed statins. Eligibility for statin therapy also significantly increased, but statin intensity adherence remains unclear.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Clinical Pharmacy
Background:
- The 2013 American College of Cardiology (ACC) and American Heart Association (AHA) updated lipid guidelines marked a significant shift from previous recommendations.
- Concerns arose about the potential increase in adults eligible for lipid-lowering therapies, particularly moderate to high-intensity statins.
Purpose of the Study:
- To evaluate the impact of the 2013 ACC/AHA lipid guidelines on statin prescription rates and patient eligibility in the first year post-release.
- To compare statin prescribing patterns and eligibility in 2014 against the preceding year (2013).
Main Methods:
- A retrospective, cross-sectional, observational analysis using the National Ambulatory Medical Care Survey (2013-2014).
- Exclusion criteria included patients <40 or >75 years, pregnant individuals, and those with triglyceride levels ≥400 mg/dL.
- Descriptive analyses and chi-squared tests were employed to assess differences and calculate odds ratios (ORs) with 95% confidence intervals (CIs).
Main Results:
- A higher percentage of patients were prescribed statins in 2014 compared to 2013 (OR=1.22; 95% CI, 1.00-1.48).
- Patient eligibility for statin therapy significantly increased in 2014 versus 2013 (OR=9.26; 95% CI, 7.54-11.37).
- While more patients received higher-intensity statins in 2014, this increase was not statistically significant (OR=1.17; 95% CI, 0.90-1.52).
Conclusions:
- The first year following the 2013 ACC/AHA guideline release saw an increase in statin prescriptions in the United States.
- The updated guidelines likely contributed to a greater number of patients being eligible for statin therapy.
- Adherence to the recommended intensity of statin therapy under the new guidelines requires further investigation.
Purpose:
The American College of Cardiology (ACC) and the American Heart Association (AHA) introduced new lipid guidelines in late 2013 that were a vast departure from older guidelines. Concerns were raised regarding the likely increase in the number of adults who would be eligible for lipid-lowering therapy, namely moderate to high intensity statins. We sought to determine whether, in the first year after the ACC/AHA guideline release, more patients were prescribed statins, prescribed moderate- to high-intensity statins, and eligible for statins compared with the previous year.
Methods:
This study was a retrospective, cross-sectional, observational analysis of National Ambulatory Medical Care Survey collected by the Centers for Disease Control and Prevention during the years 2013 and 2014. Survey participants who were younger than 40 years or older than 75 years, were pregnant, or had triglyceride levels ≥400 mg/dL were excluded. Descriptive analyses and χ2 tests of homogeneity (and associated odds ratios [ORs] and CIs) were constructed and reported.
Findings:
Compared with 2013, a higher percentage of patients in 2014 were prescribed a statin and were eligible to receive a statin. In fact, patients in 2014 were significantly more likely to be prescribed a statin (OR = 1.22; 95% CI, 1.00-1.48) and to be eligible for a statin (OR = 9.26, 95% CI 7.54-11.37) compared with 2013. Although a higher percentage of patients in 2014 were prescribed a higher-intensity statin, the difference was not statistically significant (OR = 1.17; 95% CI, 0.90-1.52).
Implications:
In the first year after the ACC/AHA guideline introduction, more patients in the United States were prescribed a statin. However, it is unclear whether the new guidelines were strictly adhered to regarding intensity of statin therapy.
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