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Stephanie Yu1, Kiumars Zolfaghari2, Karen L Rascati3
1Department of Pharmacy, Baylor Scott & White Health, Temple TX, USA.
Insights
High-intensity statin use increased after 2013 guidelines, but low-density lipoprotein cholesterol (LDL-C) levels remained unchanged. This suggests current statin guidelines may not be effectively lowering LDL-C in atherosclerotic cardiovascular disease (ASCVD) patients.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- The 2013 ACC/AHA guidelines recommended increased high-intensity statin use for atherosclerotic cardiovascular disease (ASCVD) management.
- Previous observations noted a rise in high-intensity statin prescriptions but no significant change in low-density lipoprotein cholesterol (LDL-C) levels post-guideline release.
Purpose of the Study:
- To evaluate statin therapy goal achievement in ASCVD patients before and up to four years after the 2013 ACC/AHA guidelines.
- To compare outcomes against prior LDL-C goals of <70 mg/dL and <100 mg/dL.
Main Methods:
- A single-system cohort study analyzed medical records, lab results, and claims data from November 2012 to October 2017.
- Propensity score-matched analyses were conducted on adult patients with at least one statin claim and an ASCVD diagnosis.
Main Results:
- High-intensity statin use in 1938 ASCVD patients significantly increased from 24% in 2013 to 49% in 2016.
- Subspecialist management correlated with a 13-22% higher increase in high-intensity statin use compared to primary care.
- Mean LDL-C levels showed no significant change, fluctuating between 80-85 mg/dL, and goal attainment rates for LDL-C <70 mg/dL (51-56%) and <100 mg/dL (77-85%) remained stable.
Conclusions:
- High-intensity statin use significantly increased post-2013 ACC/AHA guidelines, particularly under subspecialist care.
- Despite increased statin intensity, mean LDL-C levels and goal attainment did not improve, indicating a potential gap in achieving therapeutic targets.
Background:
Previous research demonstrates increased utilization of high-intensity statins, but unchanged low-density lipoprotein cholesterol (LDL-C) levels, immediately after the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline release.
Objective:
The objective of this study was to determine achievement of statin therapy goals in patients with atherosclerotic cardiovascular disease (ASCVD) before and up to 4 years after the 2013 ACC/AHA guideline release compared with LDL-C goals of <70 mg/dL and <100 mg/dL previously recommended by other professional societies.
Methods:
The single-system cohort study used medical records, laboratory results, and claims data (November 2012-October 2017) of adults with ≥1 claim for a statin, ≥1 ASCVD diagnosis in propensity score-matched analyses.
Results:
Among 1938 patients (mean age 70 ± 11, 48% female) with ASCVD, the percentage on high-intensity statin therapy significantly increased over time: 24% in 2013, 34% 2014, 42% 2015, and 49% 2016 (P < .0001). The increase in high-intensity statin use was 13 to 22% higher among patients managed by subspecialists (cardiologist and endocrinologists) compared with those managed by primary care providers. Mean LDL-C level was slightly, but not significantly, lower in 2013 (80 mg/dL) than in other years: 85 mg/dL in 2014, 83 mg/dL in 2015, and 82 mg/dL in 2016. The proportion of patients reaching LDL-C goals ranged from 51% to 56% for the <70 mg/dL target and 77% to 85% for the <100 mg/dL target over time.
Conclusion:
High-intensity statin use among secondary prevention patients increased significantly immediately after the 2013 ACC/AHA guidelines release, primarily in those managed by subspecialists. However, the mean LDL-C and the proportion of patients reaching LDL-C < 70 mg/dL and < 100 mg/dL remain unchanged across comparison cohorts.
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