Related Experiment Video
Updated: Dec 6, 2025
Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Utilization of High-Intensity Statins in Patients at Risk for Cardiovascular Events: A National Cross-Sectional Study
John M Moorman1, Jaclyn Boyle1, Leah Bruno1
1Department of Pharmacy Practice, Northeast Ohio Medical University College of Pharmacy, Rootstown, OH.
Insights
High-intensity statin use increased after 2013 guidelines but remains suboptimal, particularly for Black and Hispanic patients. This highlights opportunities to improve care for atherosclerotic cardiovascular disease risk.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- The 2013 ACC/AHA cholesterol guidelines shifted from target-based management to risk-based stratification for atherosclerotic cardiovascular disease (ASCVD).
- The impact of these guidelines on high-intensity statin prescribing patterns in the U.S. was not well-defined.
Purpose of the Study:
- To assess the change in high-intensity potential (HIP) statin use before and after the 2013 guidelines.
- To identify patient and clinical factors associated with HIP statin prescribing.
Main Methods:
- A national cross-sectional study utilized data from the National Ambulatory Medical Care Survey (NAMCS).
- Office visits for patients aged 21-75 meeting criteria for HIP statin therapy were analyzed.
- Multivariate logistic regression identified predictors of HIP statin prescribing.
Main Results:
- HIP statin use increased from 9.5% before 2013 to 16.5% after (OR 1.88).
- Key predictors included antihypertensive use (OR 5.38) and hyperlipidemia (OR 2.93).
- Black (OR 0.63) and Hispanic (OR 0.65) patients showed lower HIP statin prescribing rates.
Conclusions:
- The 2013 guidelines were associated with increased HIP statin prescribing, though rates remain lower than anticipated.
- Significant racial and ethnic disparities in HIP statin use were observed.
- There are opportunities to enhance ASCVD risk management through improved statin prescribing, especially in minority populations.
Background:
The 2013 American College of Cardiology/American Heart Association cholesterol guidelines, which identified four groups of patients at risk for atherosclerotic cardiovascular disease events, departed from the target-based approach to managing cholesterol. The impact of these guidelines on high-intensity statin use across the United States is unclear.
Study Question:
The primary objective was to evaluate the rate of high-intensity potential (HIP) statin use before and after the 2013 guidelines. The secondary objective was to identify predictors of HIP statin use within the study population.
Study Design:
A national cross-sectional study was conducted using data from the National Ambulatory Medical Care Survey. Office visits involving patients aged 21-75 years where criteria for HIP statin therapy were met were included. Visits involving pregnant patients were excluded.
Measures And Outcomes:
Prescribing trends of HIP statins were measured from National Ambulatory Medical Care Survey data before and after the 2013 guidelines. Multivariate logistic regression identified variables associated with prescribing HIP statins.
Results:
A total of 48,884 visits were included, representing more than 940 million office visits nationally. HIP statins were listed in 9.5% and 16.5% of visits before and after 2013, respectively (odds ratio [OR] 1.88; 95% confidence interval [CI] 1.62-2.20). The strongest predictors of HIP statin use were antihypertensive use (OR 5.38, 95% CI 4.67-6.20), comorbid hyperlipidemia (OR 2.93, 95% CI 2.62-3.29), Black race (OR 0.63, 95% CI 0.49-0.81), and Hispanic ethnicity (OR 0.65, 95% CI 0.52-0.80).
Conclusions:
Prescribing rates for HIP statins increased after the release of the 2013 guidelines. The prescribing rates were lower than expected, especially in Black and Hispanic patients. These observations signify opportunities to improve the quality of care for patients who are at risk for atherosclerotic cardiovascular disease events in the United States.
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:26Atherosclerosis III: Management
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:26Coronary Artery Disease IV: Preventive Measures
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:26Angina IV: Management