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Guidelines impact cholesterol management.

Stephanie Yu1, Kiumars Zolfaghari2, Karen L Rascati3

  • 1Department of Pharmacy, Baylor Scott & White Health, Temple TX, USA.

Journal of Clinical Lipidology
|April 18, 2019
PubMed
Summary
This summary is machine-generated.

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.

Keywords:
2013 ACC/AHAl2018 ACC/AHAASCVDCholesterolDyslipidemiaHigh-intensityHyperlipidemiaLDL-CNon-HDLStatin

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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.