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High-Intensity Statin Use Among Patients With Atherosclerosis in the U.S
Adam J Nelson1, Kevin Haynes2, Sonali Shambhu2
1Duke Clinical Research Institute, Durham, North Carolina, USA.
Insights
Preventive statin therapy for atherosclerotic cardiovascular disease (ASCVD) remains underused, especially for women and younger patients. High-intensity statin use shows gaps, despite good adherence among users.
Area of Science:
- Cardiovascular Medicine
- Pharmacotherapy
- Public Health
Background:
- Preventive therapy for established atherosclerotic cardiovascular disease (ASCVD) is often underutilized.
- The impact of recent guideline changes on high-intensity statin use in ASCVD patients is unclear.
Purpose of the Study:
- To assess statin utilization patterns and identify predictors of statin use in patients with established ASCVD.
- To evaluate the intensity of statin therapy prescribed and adherence levels.
Main Methods:
- Retrospective cohort study using pharmacy and medical claims data from a commercial health plan.
- Analysis of patients with established ASCVD between January 31, 2018, and January 31, 2019.
- Multivariable logistic regression to identify factors associated with statin intensity and use.
Main Results:
- Out of 601,934 ASCVD patients, only 22.5% used high-intensity statins; 49.9% used no statin.
- Younger patients, females, and those with higher comorbidity scores were less likely to receive any statin.
- Females, older patients, and those with peripheral artery disease were less likely to receive high-intensity statins.
Conclusions:
- Significant underuse of statins persists in a contemporary ASCVD population in the US.
- Gaps in appropriate statin use are particularly evident in younger patients, women, and those with noncoronary ASCVD.
Background:
Preventive therapy among patients with established atherosclerotic cardiovascular disease (ASCVD) is generally underused. Whether new guideline recommendations and a focus on implementation have improved the use of high-intensity statins is unknown.
Objectives:
This study sought to evaluate the patterns and predictors of statin use among patients with ASCVD.
Methods:
In this retrospective cohort study, pharmacy and medical claims data from a commercial health plan were queried for patients with established ASCVD between January 31, 2018, and January 31, 2019. Statin use on an index date of January 31, 2019, was evaluated, as was 12-month adherence and discontinuation. Multivariable logistic regression was used to determine independent associations with statin use of varying intensities.
Results:
Of the 601,934 patients with established ASCVD, 41.7% were female, and the mean age was 67.5 ± 13.3 years. Overall, 22.5% of the cohort were on a high-intensity statin, 27.6% were on a low- or moderate-intensity statin, and 49.9% were not on any statin. In multivariable analysis, younger patients, female patients, and those with higher Charlson comorbidity score were less likely to be prescribed any statin. Among statin users, female patients, older patients, and those with peripheral artery disease were less likely to be on a high-intensity formulation, whereas a cardiology encounter in the prior year increased the odds. The majority of high-intensity stain users achieved high levels of adherence.
Conclusions:
Substantial underuse of statins persists in a large, insured, and contemporary cohort of patients with ASCVD from the United States. In particular, concerning gaps in appropriate statin use remain among younger patients, women, and those with noncoronary ASCVD.
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